Long considered the stepchild of physical health, behavioral health care hasn’t always gotten the attention it deserves at traditional medical facilities. But now, striking statistics and troubling trends are catching the eye of C-suite executives at some of the nation’s top hospitals.
In fact, addressing rising suicide and addiction rates is top of mind for professionals at Rush University System for Health, CEO Ranga Krishnan said Thursday during Crain’s annual Hospital CEO Breakfast in Chicago.
“People are dying — between [age] 18 and 64 — at a much higher rate than expected and different from other countries,” Krishnan told event attendees. “It can’t be ignored, and it’s a huge problem.”
Chicago-based Rush is a top-ranking academic health system with locations across the Chicagoland area.
Krishnan joined three other hospital CEOs on the panel, which featured executives from NorthShore University HealthSystem, Loretto Hospital and Linden Oaks Behavioral Health. In addition to other topics, the leaders discussed current and future trends shaping health care.
For Krishnan, among the most “alarming” was the rising trend of American “death by despair” — or in other words, death by drug overdose, suicide, liver disease or similar conditions rooted in behavioral health issues.
He pointed to data published earlier this year in JAMA to illustrate the problem.
Researchers found that the average American lifespan is getting shorter, largely due to a rise in mental and behavioral health conditions nationwide. The data is especially striking for young and middle-aged populations: Between 2010 and 2017, there was a 6% rise in mortality among those 25 to 65.
At Rush, Krishnan sees these problems first-hand.
About 18% to 20% of all patients have opioids or alcohol in their system when admitted to Rush, Krishnan said. Not only does that have implications on their physical health and mortality — but also on health care costs.
“It increases the [average] length of stay by one day,” Krishnan said.
While Krishnan didn’t identify any immediate solutions to the problem, Gina Sharp, president and CEO of Linden Oaks Behavioral Health, shared some of her own — or rather her system’s.
Naperville, Illinois-based Linden Oaks provides a variety of inpatient, outpatient and recovery services for those suffering with mental health conditions, substance abuse problems and eating disorders.
It’s also part of Edward-Elmhurst Health, a large integrated health system in Illinois, with two medical hospitals in addition to Linden Oaks.
Across all those facilities, Edward-Elmhurst Health co-locates physical and behavioral health workers in an effort to better integrate treatment for patients, improving care and preventing worse problems down the road.
“We have social workers and counselors co-imbedded throughout our emergency departments,” Sharp said. “We have identified units within our medical hospitals [for] individuals who have a primary medical diagnosis with a secondary mental health [diagnosis], so we have trained staff who know how to work with those individuals and know how to treat them better.”
Such integration is key to detecting and treating behavioral health conditions in the first place, as many often go unaddressed. When that happens, patients end up in more costly care settings, such as emergency rooms.
In fact, one in eight visits to the ER is related to a mental health or substance abuse issue, research suggests. Additionally, as many as 40 percent of primary care patients have a mental illness, according to SAMHSA.
To capture the latter, Edward-Elmhurst Health also co-embeds therapists and psychologists in primary care and specialty clinics, in addition to using risk assessments and questionnaires.
“When an individual presents within the primary care physician office, we can help identify what level of care do they need and try to get them into that right level of care,” Sharp said.