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Allina Health is no different than the rest of health care when it comes to the challenges of delivering mental health services to its patients in 2022.

“Our demand for psychotherapy services outpaces what we can possibly provide even if we kept hiring aggressively and grow,” says Brian Palmer, MD, MPH, VP of Mental Health and Addiction at Allina Health.

Across the country, providers are facing a mental health provider shortage at a time when people need these services more than ever thanks to the stresses of the pandemic. According to USA Facts, a not-for-profit, nonpartisan civic initiative, 122 million Americans were living in areas experiencing mental health professional shortages as of March 31 of last year, which amounts to nearly 40 percent of the population.

In fact, some states, such as Wyoming and Utah, have the largest proportion of population living in mental health shortage areas, at 96.4 percent and 83.3 percent respectively. In Minnesota, where Allina Health primarily operates, 74 out of 87 counties have been designated by the federal government as mental health professional shortage areas.

For this reason, Allina has turned to digital health as a potential solution for mental health services, eventually to be used across the health system’s 14 hospitals and 90+ clinics. Palmer says that digital health tools have helped the health system manage capacity, particularly through the usage of its SilverCloud Health application, which provides patients with the ability to manage their symptoms of anxiety and depression asynchronously.

“They don’t have to come to an appointment, they can still use the skills they need to manage their condition and it helps us manage capacity, drive value and serve the community,” Palmer says. “We talk about whole-person care at Allina and value-based care, mental health is at the center of that. If we can help people manage their mental health and addiction symptoms, we know that impacts the rest of their health care, in terms of utilization, value and quality of their life.”

Clinically driven

According to a survey from the National Alliance on Mental Illness, there is increasing desire from patients to use technology in support of their mental health condition. Two-thirds of patients surveyed by NAMI seeking mental health treatment or support services have used technology in their search.

However, many who are using these services often find that they are inadequate. Nearly half of respondents (47 percent) reported that navigation tools have out-of-date and inaccurate information. Furthermore, an analysis of mental health apps, published in PLOS Digital Health, found that there had yet to be convincing evidence that they had an impact on symptoms for anxiety, depression and other conditions. The analysis didn’t say that these apps could never be useful in mental health interventions, but that there was not enough data to suggest they had done anything to date.

To address this potential challenge, leaders at Allina were able to understand the problem they wanted to solve via these apps before implementation begun. When organizations don’t know why they’re investing in these digital solutions, they probably won’t be as successful, Palmer says. He also says that solutions will be more effective if they have a clinical compass.

Since Allina wanted to increase access to mental health and give patients the ability to manage conditions asynchronously, it was decided use of the app would be guided by mental health coaches and connected to the patient’s primary care provider. He says this is necessary if the app is going to be used as a source of treatment.

“This keeps the care [being done through the app] connected to primary care and allows us, if someone isn’t doing well or progressing correctly with the modules, to connect them with a real human being who has a line of sight into how they are doing,” says Palmer. “I think the field is still finding its way. Having a clinical compass that says ‘this is what we consider good medical care for anxiety and depression’ ensures it’s being set up in a way that adheres to those principles. That’s what’s anchored us here at Allina.”

Palmer says there’s a difference between patient education and specific treatment. There are modules in the digital health app that are good for all Allina patients, around resiliency and mindfulness. There are also modules that are specific to patient’s condition, which need to be thoroughly vetted and monitored. There was a lot of internal discussion and careful thought before the app ever went live, says Palmer.

“When we first started on this journey, there were some of our patient experience folks and our digital team that wanted to go fast, for understandable reasons regarding patient satisfaction and making sure we’re on the front edge of this trend. We had to make sure we’re doing this from a way that’s clinically led and driven, to understand the problem we’re trying to solve and to not be afraid to find the right partner,” Palmer says.