Although 21% of U.S. adults have a mental illness, access to behavioral healthcare remains out of reach for most. From 2008 to 2019, the number of adults with any mental illness increased nearly 30%. The pandemic further exacerbated mental health problems for adults and sparked an expanding youth mental health crisis. As the demand for behavioral healthcare continues to grow, Magellan Healthcare recognizes the need to increase access.

Increasing Access to Evidence-based Care

Magellan has collaborated with NeuroFlow, an award-winning behavioral health technology company, to increase access to our evidence-based digital cognitive behavioral therapy (DCBT) programs and enhance engagement. With a history of over 20 years of research and development and an endorsement from the Substance Abuse and Mental Health Services Administration (SAMHSA), Magellan’s DCBT programs are integral components of our Digital Emotional Wellbeing program, including FearFighter® for anxiety, panic and phobia and MoodCalmer for depression. Both programs, as well as RESTORE® for insomnia and other difficulties sleeping, are available online in Spanish, further increasing access to evidence-based programs.

Understanding Digital Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a short-term intervention that behavioral health clinicians use to help individuals overcome negative thoughts and behaviors. CBT is effective for depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders, and severe mental illness. CBT has been demonstrated to be as effective in certain conditions as other forms of therapy or psychiatric medications. Digital CBT (DCBT) is the implementation of CBT on a digital platform with the same core principles, language and exercises used in live practice that include:

• Learning to recognize thought distortions
• Evaluating distortions against reality
• Gaining a better understanding of others’ behavior and motivations
• Using problem-solving skills
• Developing a greater confidence in one’s own abilities
• Changing behavioral patterns
• Developing coping skills

True evidence-based DCBT follows the exact CBT process, differing from evidence-informed digital programs that use some CBT practices but are not built with fidelity to the intervention model. Learn more about evidence-based vs. evidence-informed behavioral health interventions here.

Impact of FearFighter and MoodCalmer on Mental Health

Our collaboration with NeuroFlow has yielded remarkable outcomes that underscore the power of innovative partnerships. In a recent study, members participating in the Digital Emotional Wellbeing program who completed 75% or more of FearFighter and MoodCalmer reported significant reductions in anxiety and depression symptoms within 90 days.

• FearFighter users experienced a 41% average reduction in Generalized Anxiety Disorder Assessment (GAD-7) scores, compared to other DCBT users who averaged an 11% reduction in GAD-7 scores.
• MoodCalmer users experienced a 24% average reduction in Patient Health Questionnaire (PHQ-9) scores, compared to an average 13% reduction among those who completed less of the program.

Beyond these impressive results, Magellan has seen a 124% increase in registrations after launching Digital Emotional Wellbeing over previous programs. Members also report high levels of satisfaction with the Digital Emotional Wellbeing program with 85% indicating they would recommend the program to someone else.

Visit Magellanhealthcare.com/digital-bh/ to learn more about the results and how our Digital Emotional Wellbeing program, including our award-winning DCBT programs improve anxiety, depression and more.

Sources:

• Exploring Barriers to Mental Health Care in the U.S. | AAMC
• What is Cognitive Behavioral Therapy? (apa.org)
• Satiani A, Niedermier J, Satiani B, Svendsen DP. Projected Workforce of Psychiatrists in the United States: A Population Analysis. Psychiatr Serv. 2018 Jun 1;69(6):710-713. doi: 10.1176/appi.ps.201700344. Epub 2018 Mar 15. PMID: 29540118.

FearFighter® and MoodCalmer are owned by CCBT Limited Corporation, United Kingdom. CCBT has granted Magellan exclusive rights to FearFighter® and MoodCalmer in the U.S.

Over the past decade, technology has become enmeshed in our lives. From the ubiquitous smartphones we all carry, to connected houses, cars, cameras and more — it seems like just about every object we come into contact with is gaining new capabilities from being connected to the cloud. At Magellan Health, we feel strongly that an individual’s health should benefit from these technological advancements, too.

We are excited to announce that Magellan is expanding its existing collaboration with Click Therapeutics to create Food and Drug Administration (FDA) cleared therapeutic apps.

Digital health apps are an area that Magellan continues to lead in research and development. Magellan’s Director of Innovation, Brian Keenaghan, recently shared his experience building apps to promote healthy vibrant lives.

 FDA Clearance for Digital Therapeutics

Click will leverage Magellan’s portfolio of software programs, associated intellectual property, and data to create mobile apps for people challenged by conditions such as insomnia, substance abuse, depression and anxiety, and apply for FDA clearance for such apps on the basis of valid scientific evidence supporting the safety and effectiveness of the software. This augments Magellan’s work to provide broad-based, digital and data-driven programs for primary care and specialty care providers.

Magellan Health and Click Therapeutics: Rethinking Healthcare

Last year, Magellan launched a tobacco cessation program with Click Therapeutics leveraging Magellan’s clinical coaching and pharmacy benefit management (PBM) capabilities with Click’s technology and machine learning platform, including the mobile application, CLICKOTINE®, to create an all-in-one solution.

Magellan’s CCBT modules have undergone numerous clinical trials in which they have matched, and in some instances exceeded, those reached by conventionally delivered cognitive behavioral therapy. In addition, Cobalt has received the highest rating from the Substance Abuse and Mental Health Administration’s (SAMHSA) National Registry of Evidence-based Programs and Practices (NREPP).

You can learn more about Magellan’s Cobalt CCBT capabilities here.

To mark Mental Health Month, we had the opportunity to sit down with Dr. Caroline Carney, chief medical officer of Magellan Healthcare. Dr. Carney shed some light on stigma, barriers to mental health services and ways we can all help all friends and family get the treatment they need to live a healthy, vibrant life.

Why is there still a stigma around seeking help or treatment for mental health concerns?

Dr. Carney: I think we first need to talk about what stigma is, and where it comes from.

Unfortunately, people with mental illness have been stigmatized by others, and even by themselves. Mental illness is often still perceived as an indulgence, a sign of weakness, or as a character weakness. You also may find people who believe mental illness is something that is scary, or to be made fun of. So many myths exist about mental illness, including that it is the result of bad parenting. Popular culture continues to further the stereotypes and myths.

Further, self-stigmatization is a huge driver for this. Self-stigmatization occurs when shame and secrecy override even the most extreme of symptoms, preventing people from getting the help they need. Few people recognize how prevalent mental illness is.  We don’t talk about depression. We don’t talk about our own perceived failures. We don’t talk about how tough life can be, and often suffer through it in silence. Further, the symptoms themselves, whether depression, anxiety or psychotic disorders, often contribute to a sense of isolation. In the time of Facebook and Instagram, we are led to believe that everyone lives a happy and interesting life every day. If you feel you don’t measure up to what is shown on social media, it can then be perceived as a failure. This is especially true for adolescents, teens and college-aged kids. I’ve spoken recently to a young person who was afraid to talk to her best friend and to her mentor about her feelings of depression and loneliness. She was afraid they would think that she was weak and flawed—therefore not worthy of being a good friend. Instead, she suffered in silence, further worsening the symptoms until suicide became part of her daily thoughts. Most people around her would never recognize this incredible kid regularly thinks of suicide. This, unfortunately, is an all too common scenario.

What can friends, family and coworkers do to help lessen that stigma and encourage people to seek help?

Dr. Carney: I think the biggest step is to support and withhold judgement. Family and friends need to be upfront about symptoms or conditions they’ve had in their own lives. I often advise that it is a normal, common thing to get treatment—it should be considered no different than getting treated for any medical condition. In some cases, friends and family may find themselves helping someone access treatment at a mental health provider or a primary care physician. Emphasizing that mental illness isn’t a sign of failure, and can actually be treated, is critically important. As a doctor, I have often counseled the loved ones of my patients that it can be frustrating to take care of a person in the thick of an episode of mental illness. The symptoms of depression, for instance, dampen ones motivation, support beliefs of hopelessness, and take away energy. It should be no surprise, then, that the person suffering from mental illness doesn’t want therapy. Don’t give up on them—understand that the disease itself influences getting treatment.

Treatment for mental illness doesn’t happen overnight—it can often take weeks or even longer for a response to occur. Family, friends, coworkers, and providers shouldn’t give up.  Look for incremental change, not overnight cures.

What is the biggest misperception about mental illness? 

Dr. Carney: The biggest misperception is that mental illness isn’t an illness—that is something one brings upon oneself. Mental illness is caused by biological, genetic, and environmental factors.

Can you live a life of recovery?

Dr. Carney: Absolutely! Because mental illness is a medical condition, it’s important to know about different mental conditions and their associated treatment options. A common myth is that the illness will go away if a stressor is removed, or time passes, or a person just thinks positive thoughts or prays. Think about a physical illness such as diabetes. Diabetes won’t go away with positive thinking, and neither will a condition like depression. Mental illness can be treated, and the earlier treatment is initiated, the better the chances of recovery. Finding licensed, trained providers is essential. Using social supports like faith or your peers can be an extension of, not a replacement for, treatment.  Importantly, having an episode of depression or an anxiety disorder may only occur once in a lifetime. If the root causes are uncovered, cognitive distortions are addressed, and if appropriate, medication used correctly, the morbidity of mental illness can be markedly reduced, and may never come back. Even people with serious persistent mental illness, such as schizophrenia, can live a life of recovery with the right supports and treatment.

But I also think it’s essential that we need to educate people that the illness may return. This doesn’t mean that a person with mental illness failed. It means that the illness may be chronic, but the symptoms can still be treated.

The most vital concept to remember is that recovery is possible, and can be permanent.  When it’s not permanent, treatment can be ongoing and very successful.

What can providers/clinicians do to help reduce stigma?

Dr. Carney: I think there are a few ways that everyone – not only providers or clinicians – can help counter stigma around mental illness.

• Know the facts about mental illness—read about mental illness from expert and advocacy groups like the National Alliance on Mental Illness (NAMI), the National Institute of Mental Health, the Substance Abuse and Mental Health Services Administration (SAMHSA) and other sites.  Rumor and innuendo never serve the facts.
• Continue to reinforce that this is an illness, and not a sign of weakness or failure.
• Take a look at your own attitudes and how you think about mental illness—whether your own, in someone you care about or the stranger you see on the street.  Understand that no one would ever want to be depressed, or be troubled by hallucinations. Mental illness is an illness, no less than heart disease or cancer.
• Choose your words carefully—Often we refer to someone who has diabetes as a diabetic, or a person with schizophrenia as a schizophrenic. People are more than their disease, whatever it may be. We need to preserve personal dignity by recognizing that our words matter—use terms like “he is a man with schizophrenia,” and be mindful of common phrases like “crazy” or “nuts.”
• Provide support by keeping your loved one or friend safe from harm. Participate in therapy when asked. Avoid passing judgement, especially about how quickly someone’s recovery may be progressing, and continue to support the receipt of treatment.
• Take an honest look about what environmental factors may be contributing to the illness.  Evaluate short-term and long-term stressors.  Just like we would monitor the diet for someone with diabetes, we should recognize that environmental factors contribute to mental illness, just as they do to physical health.
• Never accept or foster stereotypes.

It’s 11:30 on a Tuesday night in the emergency department of a local county hospital. The doctor pulls back the curtain on his next patient and frowns. He has seen this man before. He looks down at the chart and recognizes the name. He’d been in about eight weeks before with trouble breathing and chest pains. Gears click in doctor’s memory, as he recalls this patient. His medical work-up had shown nothing acutely wrong. He’d been encouraged to take his usual medications, and sent home with instructions to see his regular doctor as soon as possible to make sure his chronic diabetes and congestive heart failure were under good control.

The doctor pulls a stool across the floor and sits down bedside.

“Hi Brian, what seems to be the trouble?”

“My chest. I couldn’t breathe. And I can’t seem to concentrate. I just don’t want to do anything.” Brian’s voice is listless and low, and he looks fatigued.

“I see you were in a couple of months ago. Did you go and see your regular physician?”

Brian shrugs but doesn’t say anything. His eyes are fixed firmly on the floor.

The doctor pauses. He looks at Brian for a while. The man looks like he hasn’t taken care of himself. His clothes are wrinkled, and he’s lost some weight since his last visit to the emergency department. The doctor looks over Brian’s vitals and labs. He finds nothing concerning on physical exam. He asks, “Brian, has anyone ever talked to you about depression?”

In the case above, Brian is a fictional character, but the situation is not. The co-occurrence of mental health disorders with physical ailments is common. A Substance Abuse and Mental Health Services Administration (SAMHSA) report found that 68 percent of adults with mental disorders have medical conditions, and 29 percent of adults with medical conditions have mental disorders. The most common of these is depression. Many research studies have found high rates of comorbid depression with chronic and terminal medical conditions. In many cases, the medical conditions or treatments for the conditions can cause depression. In others, the depression itself can lead to health behaviors that cause or worsen medical illness, and even higher risk of death. For instance, persons with depression have higher rates of smoking cigarettes than the general public. This can lead to heart disease. But, depression itself can also cause changes in brain chemistry and platelets, which can worsen existing heart disease.

Common Conditions with Comorbid Depression

Comorbid depression in some medical conditions is common. According to the National Institute of Health, there is a close relationship between depression and other physical ailments:

• Alzheimer’s disease and other dementias
• Cancer
• Coronary artery disease
• Congestive heart failure
• Diabetes
• Epilepsy
• HIV/AIDS
• Multiple sclerosis
• Parkinson’s disease
• Rheumatoid arthritis
• Stroke
• Systemic lupus erythematosus

Depression also has a negative effect on treatment and outcomes for these diseases. A 2015 published research study showed those with comorbid depression had more negative outcomes for their primary ailment than those who only had the primary ailment. Research also shows a lower quality of life, lower compliance with medical treatments, and lower rates of exercise and healthy eating habits for patients with comorbid depression compared to those with the same physical ailment(s) who did not suffer from depression.

This comorbidity has consequences beyond the health of the patient. People with multiple medical conditions are a rapidly growing and extremely costly segment of the US population. Patients with behavioral health disorders spend more on treatment for general medical conditions. When compared to those without depression, overall health care spending for medical conditions is higher than those without, in addition to treatment for the depression itself.

Improving Care for Comorbid Behavioral Health Conditions

The first step is identifying patients with comorbid behavioral health conditions before they reach the dangerous and costly levels discussed above. The primary care setting may be the best place to first find depression. But how?

Magellan’s Screen and Engage program is an innovative, user-friendly application that primary care physicians (PCPs) can use to identify patients at risk for a mental illness. Using a Magellan-provided iPad, the patient answers questions about his or her health and well-being while waiting for an appointment. The screening tools are also available in Magellan’s Virtual Care Solutions. Magellan’s proprietary algorithms assess the results, identify potential behavioral health issues and suggest recommendations for treatment, and flag clinicians to engage the patients.

The benefits of the tool are clear. Given the limited amount of time that a PCP has for each appointment, he or she must focus the conversation on the primary reason for the visit. As such, there is little opportunity to probe for behavioral health concerns. By conducting the screening before the short appointment, the PCP has a chance to be notified of the screening results, and discuss them during the visit.

Screening for behavioral health conditions is just the first step. Step two is treating them. In general, depression is treated with either medications and/or cognitive behavioral (CBT) psychotherapy. CBT is a specific type of therapy that relies on identifying and changing ones thoughts that can lead to depression. Research shows that the combination of the two is better than either done separately. While it may be easy to receive anti-depressants from medical doctors, it is often difficult to find CBT.

Cobalt, Magellan’s computerized Cognitive Behavioral Therapy (CCBT) program, is a cost-effective solution to address common behavioral health conditions. Cobalt provides CCBT online or through a smartphone/tablet app. This makes face-to-face CBT—proven to work but often difficult to find providers, especially in rural areas and for working people—available anywhere, any time. It is also a more private approach to CBT. Patients can access treatment from their homes versus an office.

Computerized CBT has proven to be just as effective as in-person CBT. Magellan offers Cobalt modules for insomnia, depression, anxiety, substance use disorder and obsessive-compulsive disorder, treating more than 90 percent of behavioral health conditions seen in primary care and behavioral settings.

Tackling Comorbid Conditions for a Healthy Future

At Magellan, we have made it our mission to help individuals like Brian, whose case is all too common. Tackling comorbid behavioral health issues alongside common medical conditions is one way we do it. Investing in and using new technology, we can identify more people who need help and expand their access to effective, proven treatments.

Trouble sleeping? You are not alone. Sleep problems and insomnia affect nearly 40 percent of Americans each year. Not only is insomnia very common, it is also associated with increased risk of stroke,^[1] diabetes,^[2] obesity,^[3] alcohol misuse,^[4] depression^[5] and anxiety.^[6]  When individuals have insomnia and another one of these conditions, it can be particularly problematic. Cognitive behavioral therapy (CBT) is widely recognized as the gold standard for long-term management of insomnia.^{[7],[8],[9],[10]} However, CBT can be difficult to access and is relatively inaccessible for individuals with limited economic security.

Through increasing access to quality, well-studied CBT programs, Magellan seeks to reduce the overall cost-of-care and improve individual health outcomes. Team members at Magellan recently collaborated with academic researchers on a project to make Magellan’s computerized CBT programs, referred to as Cobalt, accessible to patients with insomnia in a community health setting. Participants included individuals who lived in shelters and community homes, as well as individuals with serious mental illness.

Participants received access to RESTORE^TM, one of several data-driven programs in the Cobalt suite, which has been shown to be effective in randomized controlled trials. RESTORE^TM has also won praise from the American Academy of Sleep Medicine ^[11] and received the highest rating from the Substance Abuse and Mental Health Administration’s (SAMHSA) National Registry of Evidence-based Programs and Practices. The research findings, published in the Journal of Clinical Sleep Medicine, demonstrated significant improvements in sleep quality. This suggests that implementing RESTORE^TM in a community mental health center setting may make accessing effective tools for improving sleep a straightforward process.[12]

Magellan continues to lead in the healthcare field through collaborations like this one, where academic partners are collecting real-world data that demonstrate how its industry leading Cobalt programs can help increase access, lower costs, and improve individual health outcomes. We are excited by the power of technology to improve care and access to care for individuals regardless of their economic status, as we work to lead humanity to healthy, vibrant lives.

[1] Elwood, P., Hack, M., Pickering, J., Hughes, J., & Gallacher, J. (2006). Sleep disturbance, stroke, and heart disease events: evidence from Caerphilly cohort. Journal of Epidemiology Community Health 0:69-73.

[2] Cappuccio, F., D’Elia L., Strazzullo P., & Miller, M.A. (2010). Quantity and quality of sleep and incidence of type 2 diabetes. Diabetes Care; 33:414-20.

[3] Gangwisch, J., Malaspina, D., Boden-Albala, B., & Heymsfield, S.B. (2005). Inadequate sleep as a risk factor for obesity: analyses of the NHANES I. Sleep; 28:1289-96.

[4] Crum, R.M., Storr, C.L., Chan, Y-F., Ford, D.E. (2004). Sleep disturbance and risk for alcohol-related problems. American Journal of Psychiatry;61:1197-203.

[5] Riemann, D., Voderholzer, U. (2003). Primary insomnia: a risk factor to develop depression? Journal of Affect Disorder; 76:255-9.

[6] Breslau, N., Roth, T., Rosenthal, L., Andreski, P. (1996). Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults.  Biological Psychiatry;39:411-8.

[7] Schatzberg, A. F., & Nemeroff, C. B. (2009). The American Psychiatric Publishing textbook of psychopharmacology. Washington, D.C: American Psychiatric Pub.

[8] American Psychological Association. (2004). Getting a Good Night’s Sleep with the Help of Psychology.

[9] American Academy of Sleep Medicine (2013). Evaluation and Management of Chronic Insomnia in Adults.

[10] Agency for Healthcare Research and Quality. (2013). Clinical practice guidelines for the management of patients with insomnia in primary care.

[11] American Academy of Sleep Medicine. (2009). Online Cognitive Behavioral Therapy is Effective in Treating Chronic Insomnia.

[12] Feuerstein, S.D., Hodges, S. Keenaghan, B.C., Bessette, A., Forselius, E., & Morgan, P.T. (2016). Computerized Cognitive Behavioral Therapy for Insomnia in a Community Health Setting. Journal of Clinical Sleep Medicine.

Consumerization of products continues to drive new innovations across the marketplace. For example, you can use your smartphone as a GPS device, to request a car service directly to your house and to shop for a new car online, seeing the prices other people paid in real time. In banking, we’ve seen the transition from teller to the ATM to online banking, smartphone banking and now, using your smartphone as a smart pay device. Underscoring all of these innovations is the desire to make whatever experience the consumer is engaging in easier, simpler and more personalized.

Healthcare is no different. Across the healthcare continuum, companies like ours are finding new and innovative ways to enhance member engagement and participation in the healthcare journey, particularly through computerized or mobile devices. Think about how healthcare has changed over the past 50 years – house calls from doctors to office visits to telephone triage and now, computerized therapy and text therapy.

At Magellan, we’ve invested in a unique type of computerized therapy – Computerized Cognitive Behavioral Therapy (CCBT) – to help individuals seek the therapy they need, in the comfort, convenience and privacy of their own home. Our CCBT programs were originally developed more than 20 years ago, for stand-alone personal computer use, but have since been developed for use on the internet and mobile devices, in both English and Spanish.

 The following five conditions make up more than 90 percent of behavioral health complaints in adults, and are present in more than 25 percent of adults:

• Insomnia
• Depression
• Anxiety
• Substance Abuse
• Obsessive Compulsive Disorder

Within each condition, studies have shown CCBT to be effective at reducing symptoms and severity. Importantly, our CCBT programs have undergone clinical trials involving more than 1,000 patients and have received endorsements and recognition from the American Academy of Sleep Medicine, the United Kingdom’s National Institute of Clinical Excellence, Accreditation Canada and the Substance Abuse and Mental Health Administration’s National Registry. Underscoring all of the studies and reviews, what can members expect? Sixty-nine percent of users show meaningful improvement within 30 days.

But CCBT isn’t just for members. We’ve found that providers can use a tool called Smart Screening to help screen individuals and triage them to the most appropriate levels of care on the CCBT platform, and in person, for the most serious cases. Various levels of screening can help direct individuals to CCBT, directly to an in-person counselor or a mix of both. Through this triage system, 90 percent of engaged participants rate this program as helpful and useful, and 75 percent of individuals actually prefer a non-medication care option when asked.

The most important thing about innovation in any industry – healthcare, banking or electronics – is refusing to rest on your laurels. There are new start-ups launched everyday whose mission it is to disrupt the status quo and provide new ways of doing things. As healthcare evolves, we plan to do the same.

Mosquitoes carrying the Zika virus have been identified in Florida, so it’s critical that individuals living in the affected region and across the country know where to go to access information about prevention, detection and treatment. The Substance Abuse and Mental Health Services Administration (SAMHSA) has put together a website with resources about Zika, including those specific to certain groups of people, including pregnant women, parents, travelers and employers and workers. 

The impact of Zika in the United States is more than just physical. Many individuals, particularly those who live in a region where Zika has been found, may be experiencing anxiety or stress simply as a result of hearing about the disease from newspapers, television and on social media. SAMHSA has put together a tip sheet to help people cope with these feelings.

In their tip sheet, SAMHSA makes two important points:

• Set limits on how much time you spend reading or watching news about the outbreak. You will want to stay up to date on news of the outbreak, particularly if you have loved ones in places where people have become sick. But make sure to take time away from the news to focus on things in your life that are going well and that you can control.
• Find people and resources you can depend on for accurate health information. Learn about the outbreak and how you can protect yourself against illness if you are at risk. You may turn to your family doctor, a state or local health department, U.S. government agencies, or an international organization. Check out the sidebar on the next page for links to good sources of information about infectious disease outbreaks.

With 24/7 news cycles and the prevalence on social media and online news sites, it’s critical to set boundaries around how often and where you get your news. SAMHSA or other government websites, such as the Centers for Disease Control and Prevention, offer an updated overview of the current situation.

If you feel you need additional assistance, please call SAMHSA’s Disaster Distress Helpline at 1-800-985-5990 to access additional services in both English and Spanish.