如果有人面臨類似問題，就需要心理健康的預防性護理
眾所周知，關(guān)于心理健康的討論正在增加。雖然想得出結(jié)論還需要一些時間和努力，但值得欣慰是，關(guān)于長期以來被嚴重污名化的話題的討論更多了。
類似世界精神衛(wèi)生日（World Mental Health Day）的紀念活動有助于推動亟需的對話。然而，紀念日除了本身很重要，也在提醒人們每一天都要當成精神健康日。人們生活中總會遇到影響幸福感的壓力、事件和診療，新冠疫情進一步凸顯了該現(xiàn)實，所以掌握預防和護理方法以滿足心理健康需求變得至關(guān)重要。
在CVS Health旗下保險公司安泰（Aetna），我們深知輕則承受焦慮或壓力，重則長期接受臨床診療，如果有人面臨類似問題，都會存在心理和情緒健康需求。為了真正實現(xiàn)人人享有心理健康護理，我們必須了解人們面臨的問題，并從以下三個方面采取預防手段。
早期預防：解決根本問題
新冠疫情為看待心理健康帶來了新的視角，因為人們面臨著越來越多的孤獨、日常干擾和焦慮。事實上，根據(jù)安泰和晨間咨詢公司（Morning Consult）的數(shù)據(jù)，在18-34歲的美國人中，自新冠疫情爆發(fā)以來，擔心自己或家庭成員、家人或朋友心理健康的人達到驚人的65%。然而該研究還發(fā)現(xiàn)，近四分之一的受訪者對尋求幫助解決問題沒有信心。
一個行之有效的方法就是在產(chǎn)生抑郁和焦慮情緒前解決孤獨問題。我們應(yīng)該把有相同經(jīng)歷的人群組織在一起，讓面臨困境的人們不再感到孤獨。就像安泰近期為女性、非裔美國女性、母親以及有特殊需求兒童的母親主辦了Here4U高峰論壇，參會者稱與他人聯(lián)系感提升了31%，這表明該活動對參會者的心理健康產(chǎn)生了積極影響。
員工援助計劃(EAPs)也是一種預防心理健康問題升級的有效方式，該模式可以針對一系列廣泛問題，向員工提供全天候生活援助，從而降低員工無助、焦慮或抑郁的風險。事實上，一項研究發(fā)現(xiàn)，在開展員工援助計劃的公司里，員工的生活滿意度提高了24%，工作壓力降低了10%。但是我們要說的是，員工援助計劃可不僅僅是效率提升工具。安泰的員工援助計劃服務(wù)叫“生活資源”，就是為面臨壓力和焦慮、家庭沖突、法律和財務(wù)問題、悲傷和損失甚至孤獨的醫(yī)療保險會員提供支持的例證。
二級預防:早期癥狀和治療選擇
八分之一的急診科就診病例與心理健康或藥物濫用有關(guān)，說明錯過了識別早期癥狀避免發(fā)展為急癥病例的機會。個人日常生活中和與醫(yī)療保健系統(tǒng)互動時，積極主動提供心理健康資源，我們就能有效地發(fā)現(xiàn)心理健康需求的早期跡象，引導人們過上幸福生活。
對于醫(yī)療保健行業(yè)來說，分析患者數(shù)據(jù)是識別早期心理健康需求最有效的方法之一。在“次優(yōu)行動”（Next Best Actions）中，我們的數(shù)據(jù)科學家基于消費者過去行為和偏好數(shù)據(jù)，指導安泰會員選擇可能實現(xiàn)最佳整體福利的決策或服務(wù)。例如，在患有慢性病的安泰會員中，我們使用醫(yī)療索賠數(shù)據(jù)識別心理健康風險更高的成員，并主動提供援助支持。
醫(yī)療服務(wù)提供者在早期發(fā)現(xiàn)需求方面也發(fā)揮著關(guān)鍵作用，尤其是76%的醫(yī)療服務(wù)提供者表示患者里有中高比例面臨心理健康問題。我們可以向醫(yī)療服務(wù)提供者提供指南、工具和資源，識別面臨心理健康挑戰(zhàn)的人，并引導他們獲得適當?shù)淖o理，正如安泰與精神健康中心的合作，在預防心理健康問題進一步發(fā)展方面具有重要的意義。
為了支持在其他醫(yī)療保健環(huán)境中發(fā)現(xiàn)心理健康需求，CVS Health在“一分鐘診所”預約期間提供心理健康篩查，并在選定的心理健康中心授權(quán)臨床社會工作者提供虛擬或現(xiàn)場心理健康評估和治療規(guī)劃。有效的早期識別方法必然結(jié)合積極主動接觸消費者、醫(yī)療服務(wù)提供者培訓以及在當?shù)厣鐓^(qū)和其他護理環(huán)境中嵌入資源等能改善心理健康的措施。
三級預防:治療干預
干預更側(cè)重于臨床問題出現(xiàn)時采取行動，也是防止心理健康問題惡化的重要方面。我們一直在不斷改進心理健康干預模式，現(xiàn)在獲得治療比以往更容易，可以親自看心理醫(yī)生，也可以視頻會話或發(fā)送信息。
2020年，60%的安泰商業(yè)保險會員利用遠程醫(yī)療服務(wù)完成心理健康就診，而2019年這一比例僅為1%。今年仍將繼續(xù)保持較高比例，進展相當積極！有證據(jù)顯示遠程醫(yī)療對心理健康保健有效很好，對于擔心面對面接受治療的人來說，這可能是很好的選擇，因為利用遠程方式與醫(yī)療服務(wù)提供者聯(lián)系更便捷。研究還表明，將遠程醫(yī)療健康納入早期護理并增加遠程心理治療機會，可以改善患者的心理健康狀態(tài)。
我們還了解到，人們越來越希望在社區(qū)中更方便地獲得醫(yī)療服務(wù)，而且還要與整體醫(yī)保計劃和生活方式掛鉤，將身心健康治療與購買其他健康產(chǎn)品和處方藥關(guān)聯(lián)起來。有關(guān)該問題的積極探索包括：擴大向家庭派送心理健康藥物的范圍，確保人們遵從用藥指導，盡快恢復健康并預防未來的風險。
預防性護理是非常有效的方式，絕不能忽視其在各類健康問題里發(fā)揮的作用，包括對心理健康的影響。隨著人們對自身、關(guān)心的人和社區(qū)的心理健康問題關(guān)注持續(xù)上升，安泰和CVS Health將持續(xù)努力避免人們感到孤獨，同時也支持全國各地的醫(yī)療服務(wù)提供者和公司合作伙伴采取同樣措施。通過這項工作，我們可以推動社區(qū)、工作場所和家庭在心理健康方面取得進展。（財富中文網(wǎng)）
醫(yī)學博士李奎是CVS Health的高級副總裁兼安泰首席醫(yī)療官?？ɡた思{爾蒂是安泰行為健康總裁。刑恩博士是安泰首席精神衛(wèi)生官。
譯者：馮豐
審校：夏林
眾所周知，關(guān)于心理健康的討論正在增加。雖然想得出結(jié)論還需要一些時間和努力，但值得欣慰是，關(guān)于長期以來被嚴重污名化的話題的討論更多了。
類似世界精神衛(wèi)生日（World Mental Health Day）的紀念活動有助于推動亟需的對話。然而，紀念日除了本身很重要，也在提醒人們每一天都要當成精神健康日。人們生活中總會遇到影響幸福感的壓力、事件和診療，新冠疫情進一步凸顯了該現(xiàn)實，所以掌握預防和護理方法以滿足心理健康需求變得至關(guān)重要。
在CVS Health旗下保險公司安泰（Aetna），我們深知輕則承受焦慮或壓力，重則長期接受臨床診療，如果有人面臨類似問題，都會存在心理和情緒健康需求。為了真正實現(xiàn)人人享有心理健康護理，我們必須了解人們面臨的問題，并從以下三個方面采取預防手段。
早期預防：解決根本問題
新冠疫情為看待心理健康帶來了新的視角，因為人們面臨著越來越多的孤獨、日常干擾和焦慮。事實上，根據(jù)安泰和晨間咨詢公司（Morning Consult）的數(shù)據(jù)，在18-34歲的美國人中，自新冠疫情爆發(fā)以來，擔心自己或家庭成員、家人或朋友心理健康的人達到驚人的65%。然而該研究還發(fā)現(xiàn)，近四分之一的受訪者對尋求幫助解決問題沒有信心。
一個行之有效的方法就是在產(chǎn)生抑郁和焦慮情緒前解決孤獨問題。我們應(yīng)該把有相同經(jīng)歷的人群組織在一起，讓面臨困境的人們不再感到孤獨。就像安泰近期為女性、非裔美國女性、母親以及有特殊需求兒童的母親主辦了Here4U高峰論壇，參會者稱與他人聯(lián)系感提升了31%，這表明該活動對參會者的心理健康產(chǎn)生了積極影響。
員工援助計劃(EAPs)也是一種預防心理健康問題升級的有效方式，該模式可以針對一系列廣泛問題，向員工提供全天候生活援助，從而降低員工無助、焦慮或抑郁的風險。事實上，一項研究發(fā)現(xiàn)，在開展員工援助計劃的公司里，員工的生活滿意度提高了24%，工作壓力降低了10%。但是我們要說的是，員工援助計劃可不僅僅是效率提升工具。安泰的員工援助計劃服務(wù)叫“生活資源”，就是為面臨壓力和焦慮、家庭沖突、法律和財務(wù)問題、悲傷和損失甚至孤獨的醫(yī)療保險會員提供支持的例證。
二級預防:早期癥狀和治療選擇
八分之一的急診科就診病例與心理健康或藥物濫用有關(guān)，說明錯過了識別早期癥狀避免發(fā)展為急癥病例的機會。個人日常生活中和與醫(yī)療保健系統(tǒng)互動時，積極主動提供心理健康資源，我們就能有效地發(fā)現(xiàn)心理健康需求的早期跡象，引導人們過上幸福生活。
對于醫(yī)療保健行業(yè)來說，分析患者數(shù)據(jù)是識別早期心理健康需求最有效的方法之一。在“次優(yōu)行動”（Next Best Actions）中，我們的數(shù)據(jù)科學家基于消費者過去行為和偏好數(shù)據(jù)，指導安泰會員選擇可能實現(xiàn)最佳整體福利的決策或服務(wù)。例如，在患有慢性病的安泰會員中，我們使用醫(yī)療索賠數(shù)據(jù)識別心理健康風險更高的成員，并主動提供援助支持。
醫(yī)療服務(wù)提供者在早期發(fā)現(xiàn)需求方面也發(fā)揮著關(guān)鍵作用，尤其是76%的醫(yī)療服務(wù)提供者表示患者里有中高比例面臨心理健康問題。我們可以向醫(yī)療服務(wù)提供者提供指南、工具和資源，識別面臨心理健康挑戰(zhàn)的人，并引導他們獲得適當?shù)淖o理，正如安泰與精神健康中心的合作，在預防心理健康問題進一步發(fā)展方面具有重要的意義。
為了支持在其他醫(yī)療保健環(huán)境中發(fā)現(xiàn)心理健康需求，CVS Health在“一分鐘診所”預約期間提供心理健康篩查，并在選定的心理健康中心授權(quán)臨床社會工作者提供虛擬或現(xiàn)場心理健康評估和治療規(guī)劃。有效的早期識別方法必然結(jié)合積極主動接觸消費者、醫(yī)療服務(wù)提供者培訓以及在當?shù)厣鐓^(qū)和其他護理環(huán)境中嵌入資源等能改善心理健康的措施。
三級預防:治療干預
干預更側(cè)重于臨床問題出現(xiàn)時采取行動，也是防止心理健康問題惡化的重要方面。我們一直在不斷改進心理健康干預模式，現(xiàn)在獲得治療比以往更容易，可以親自看心理醫(yī)生，也可以視頻會話或發(fā)送信息。
2020年，60%的安泰商業(yè)保險會員利用遠程醫(yī)療服務(wù)完成心理健康就診，而2019年這一比例僅為1%。今年仍將繼續(xù)保持較高比例，進展相當積極！有證據(jù)顯示遠程醫(yī)療對心理健康保健有效很好，對于擔心面對面接受治療的人來說，這可能是很好的選擇，因為利用遠程方式與醫(yī)療服務(wù)提供者聯(lián)系更便捷。研究還表明，將遠程醫(yī)療健康納入早期護理并增加遠程心理治療機會，可以改善患者的心理健康狀態(tài)。
我們還了解到，人們越來越希望在社區(qū)中更方便地獲得醫(yī)療服務(wù)，而且還要與整體醫(yī)保計劃和生活方式掛鉤，將身心健康治療與購買其他健康產(chǎn)品和處方藥關(guān)聯(lián)起來。有關(guān)該問題的積極探索包括：擴大向家庭派送心理健康藥物的范圍，確保人們遵從用藥指導，盡快恢復健康并預防未來的風險。
預防性護理是非常有效的方式，絕不能忽視其在各類健康問題里發(fā)揮的作用，包括對心理健康的影響。隨著人們對自身、關(guān)心的人和社區(qū)的心理健康問題關(guān)注持續(xù)上升，安泰和CVS Health將持續(xù)努力避免人們感到孤獨，同時也支持全國各地的醫(yī)療服務(wù)提供者和公司合作伙伴采取同樣措施。通過這項工作，我們可以推動社區(qū)、工作場所和家庭在心理健康方面取得進展。（財富中文網(wǎng)）
醫(yī)學博士李奎是CVS Health的高級副總裁兼安泰首席醫(yī)療官?？ɡた思{爾蒂是安泰行為健康總裁。刑恩博士是安泰首席精神衛(wèi)生官。
譯者：馮豐
審校：夏林
It’s no secret that conversations around mental health are on the rise. Though it took a while to get here, we are proud to see more discussions take place on a topic that, for too long, has been highly stigmatized.
Observances such as the World Health Organization’s World Mental Health Day today help elevate this much needed dialogue. However, while these days are important, they also remind us to treat every day as a mental health day. People constantly face stressors, events and diagnoses that impact our overall well-being, a reality that the COVID-19 pandemic has further revealed, making it critical that our approach to preventing and caring for these mental health issues meets these needs.
At Aetna, a CVS Health company, we understand that every individual sits along a continuum of mental and emotional health needs—from facing moments of anxiety or stress to longer-term clinical diagnoses, and everything in between. To truly make mental health care a reality for all, we must meet people where they are along this continuum through a three-pronged approach to prevention.
Primary prevention: Addressing root causes
The COVID-19 pandemic has put a new lens on how we think about mental well-being, as people have faced increased levels of loneliness, routine disruption and anxiety. In fact, Aetna and Morning Consult data found that a staggering 65% of Americans ages 18-34 have had concerns about their own mental health or that of household members, family or friends since the pandemic outbreak began. Yet, the study also found that nearly one in four of the same respondents are not confident in finding help to address these concerns.
Addressing loneliness is one way we can lower feelings of depression and anxiety before they even start. Bringing together communities that have faced similar experiences, such as through forums like Aetna-hosted Here4U sessions, allows people to feel that they are not alone in the struggles they face. The Here4U sessions held recently for women, African American women, moms, and moms of children with special needs have demonstrated a positive impact on attendees’ mental health, with participants reporting a 31% improvement in feeling connected to their peers.
Employee Assistance Programs (EAPs) are also valuable modes of preventing escalated mental health concerns, as they provide 24/7 life assistance across a wide range of issues that can lower risks of feeling overwhelmed, anxious or depressed. In fact, one study found that companies with EAPs see a 24% improvement in life satisfaction and a 10% reduction in workplace distress among their workers. But we need to better inform people that EAPs are more than a workplace productivity tool. Aetna’s Resources for Living, which provides EAP services,is one example of a resource that supports those facing stress and anxiety, family conflict, legal and financial issues, grief and loss and even loneliness among our Medicare members.
Secondary prevention: Early signs and treatment options
One in eight emergency department visits are related to mental health or substance abuse, demonstrating missed opportunities to identify early signs of mental health concerns before they rise to an emergency. By proactively surrounding individuals with mental health resources, in their everyday lives and when interacting with the health care system, we can effectively spot early signs of mental health needs and direct people on the right path to well-being.
For the health care industry, one of the most effective ways we can identify mental health needs early is through patient data analysis. As part of Next Best Actions, our data scientists use consumer data on past behaviors and preferences to guide Aetna members toward decisions or services that will achieve their best total well-being. For example, we use data from medical claims to identify members with chronic conditions who are likely at higher risk for having a mental health issue and proactively reach out to them with resources for support.
Providers also play a critical role in early detection of these needs, especially with 76% reporting a high or moderate proportion of their patients face mental health issues. Arming providers with instructions, tools and resources to identify and direct those facing mental health challenges to the right care, such as through Aetna's work with PsychHub, can lead to meaningful change toward preventing further mental health concerns.
To support spotting mental health needs in other health care settings, CVS Health provides mental health screenings during MinuteClinic appointments, and licensed clinical social workers in select HealthHUB locationsprovide virtual or in-person mental health assessments and treatment planning. An effective approach to early detection combines all of these measures—proactive consumer outreach, provider training and embedding resources in local communities and other care settings—to improve mental health.
Tertiary prevention: Intervening with treatment
While intervention is more focused on the action taken when a clinical issue has already presented itself, it is an equally important aspect of preventing mental health needs from worsening. Mental health care is accessible in more ways than we’ve ever seen before—from seeing a therapist in person, to connecting virtually or over the phone to text, we are continuously evolving modes of mental health intervention.
Among Aetna’s Commercial members, 60% of outpatient mental health visits were done via telemedicine in 2020, up from just one percent in 2019. That higher figure is holding steady through this year, which is a positive development! Telemedicine has proven to be particularly effective for mental health care as it allows for greater convenience in connecting with a provider, and it can be a good option for those who are apprehensive about receiving this kind of care in person. Studies have also shown that integrating telebehavioral health into primary care and increasing access to telepsychiatry has led to improvements in patients’ mental health.
We also know that individuals increasingly want to receive care conveniently in their communities, and in a way that is connected to their overall health care plan and lifestyle—connecting their physical and mental health care to where they are shopping for other well-being products and picking up their prescriptions. The expansion of home delivery of mental health medications to ensure people adhere to medication guidance to recover and prevent future risks is another positive step in this regard.
Preventive care is powerful, and we must not forget the influence it has on all aspects of our health, including our mental well-being. As the focus on the mental health of ourselves, loved ones and communities continues to rise, Aetna and CVS Health remain committed to ensuring that no one is alone on this journey and supporting our partner providers and companies across the country to do the same. Through this work, we can make progress toward improving mental health for our communities, workplaces and families.
Kyu Rhee, M.D. is senior vice president and Aetna chief medical officer at CVS Health. Cara McNulty is the president of Aetna Behavioral Health. Hyong Un, M.D. is chief psychiatric officer at Aetna.
