Dr. Yusra Benhalim, Senior Medical Director at Optum Behavioral Health, discusses the growing rates of youth mental health challenges.
The pandemic has taken a huge toll on children across the nation. This increase in need for mental health support has led more children and adolescents to seek behavioral health care.
In this week's episode, Dr. Yusra Benhalim, Senior National Medical Director at Optum Behavioral Health discusses:
Evan Sweeney
Hello, and welcome to UnitedHealth Group’s Weekly Dose podcast, where we'll get you up to speed on the latest trends shaping the future of healthcare.
Two years after the beginning of the COVID 19 pandemic, children and adolescents across the U.S. are experiencing elevated rates of mental health issues. Recent research shows that the first year of the pandemic was particularly impactful on children, leading to higher rates of anxiety, depression and behavioral concerns. But many of these trends were building well before the pandemic and are now getting renewed attention from federal health officials and others, as the nation tries to find new solutions, create broader support and improve access to care.
Joining the podcast to discuss these trends is Dr. Yusra Benhalim, Senior Medical Director at Optum Behavioral Health.
Dr. Benhalim, welcome to the podcast.
Yusra Benhalim
Thank you so much Evan. Pleasure to be here.
Evan Sweeney01:00
Great, well, great to have you. First, can you just tell me a little bit about your background and your position at Optum?
Yusra Benhalim
Sure, so I am a board certified psychiatrist in adult child and adolescent and addiction psychiatry, and Optum. As you said, I serve as a senior national medical director and I have this incredible opportunity to work with really talented people who are truly trying to live by our mission of making the healthcare system work better for everyone, which really does include how we think about solving problems for children and families, especially nowadays, after everything we've been through.
Evan Sweeney
Yeah, well, I'm really glad that you're here to talk about this particular topic. We've seen a lot of data come through recently that really highlights some of the mental health challenges facing children and adolescents. And when you look at that data, and what you see in your own job, where do you see the biggest area of concern?
Yusra Benhalim
So I think one thing I try to remind myself and others of Evan, first of all, is that data and trends and when we talk about shifts, and what we're seeing, all of those numbers represent people, and they represent our communities. And so when we look at what we're seeing change, we are now seeing many more people reaching out their hand for help when it comes to mental health, and substance use disorder treatment. So more adults are reaching out, and more adults are reaching out on behalf of their children, whether they're teenagers or little children, we're seeing a lot more people saying I need to get help now. And so one of the biggest concerns is that the demand that we're seeing for solutions and for treatment and for support, really outweigh the supply that we have to meet all of these demands. So when we think about how many psychiatrists and therapists we have across the country, we now have more people in need. And so we're trying to think critically about how we can meet those needs in real time. And all the while start to really think creatively outside of the box to think about when someone knocks on our door when someone reaches their hand for help. How can we learn more about what they really need help with, to help sort of get them connected to the right solution, which may not necessarily always mean treatment? And it may not always mean traditional solutions? Like we've thought of them before?
Evan Sweeney
Can you talk about that a little more and what sort of, I guess solutions are coming to life recognizing that there is a real challenge around the number of providers that are available in this space?
Yusra Benhalim
So the first part that I like to help others pause on is thinking about the on ramps, thinking about how do we help people know a little bit more about the behavioral health landscape? What does the roadmap even look like? Before we start to think about solutions and, and options. So one of the key areas of our focus is thinking about ways that we can help people navigate the system, navigate the landscape, and start to learn a little bit more about what is actually on the roadmap. So if we think about the medical side of things, most of us are really lucky because we have kind of a quarterback, we have our primary care doctor or we have our pediatrician. And as a quarterback, they really help us figure out how to get to the right solutions for our health care. In Psychiatry and Behavioral Health. We don't always have that quarterback. So the first step is to think about how do we connect with people so that they can start to reach an on ramp, start to gain more access to information about well, what's really out there and behavioral health? What is the therapist? What's the difference between a therapist and a psychiatrist? How do I know if my child needs medications? And then thinking creatively? What are the other support systems out there? So not everyone needs treatment? Not everybody needs therapy. And so how can we start to make things simple, easy to use, easy to access, so that when someone is ready to make the decision for themselves or their family, they have as much information as possible, so that they can pick whatever fits them best.
Evan Sweeney
You mentioned that this is getting much more heightened attention, you know, people are sort of reaching out to a greater degree. And part I assume that attention is, is because of the pandemic, and some of the impacts of that. But can you tell me a little bit more about how this has been building even prior to that, and prior to 2020.
Yusra Benhalim
So as a psychiatrist, and especially as a child psychiatrist, I get excited that people are now talking about these things at a national level. But in the back of my mind, I remember that this is something that we face as a country for decades before the pandemic. So we saw increases and suicide rates at really significant sort of increases. So when we think about young people struggling, it's not as easy to grow up nowadays, as it was when I was younger, right, society was different technology was totally different. We didn't have social media when I was growing up. And so to grow up in this country has become hard on our young people, and they don't have all the tools and resources they need to navigate this constantly evolving world around them. And there are more risks and different risks now than there were before. So what we saw for people who are only 10 years old, all the way to about 26 years old, is it for about a decade before 2018, there was an almost 60% increase in suicide rates. And I'd like to just pause on that, because that is the rate of people who lost their life to suicide. But it doesn't reflect the number of people who had suicidal thoughts, who had self harm, who were struggling with depression or anxiety. And so we had so many people in our country who are facing these challenges before the pandemic, and the pandemic sort of just lit a fire on all of those challenges, and all of that suffering. And I appreciate that now we have the national attention, but it almost happened in a way that is causing a lot of concern about the best way to meet people's needs as soon as possible. Without breaking the system. How do we build a better system, so that a decade from now we can look back and sort of see that whatever we decide to do as a community is really not only going to solve the problem that we're facing now, but prevents something like another 60% increase in suicide rates in the next 10 years?
Evan Sweeney
To build on that a little more even I'm particularly over the last two years. I'm curious what role trauma or grief have played in sort of the increase of mental health issues that the additional attention to that? And how does that manifest into some of the trends that we're seeing right now?
Yusra Benhalim
Yes, so some people and myself included, really think about the impact of COVID as one big adverse childhood experience, that it was a very unique and unprecedented form of trauma that we all perhaps went through, through our own experiences. We know adverse childhood experiences impact the risk factors for young people to develop both medical and behavioral health conditions later on. Why is this unique to young people, if we think about it, our lives were turned upside down. But young people in particular, one of the most vulnerable populations, they lost any sort of consistency and routine, there was no such thing as predictability and safety anymore. And all of the grownups that they relied on, were also going through the pandemic. So when they reached out potentially for help or answers, they had family members who were trying their best and teachers who were doing everything they could, but they were also living in a world of uncertainty. And so imagine being the young person at the center of this tornado that's happening around them. I think young people and families did their best, and try to not just survive, but really do whatever they thought might be most helpful to them as a family unit. The truth is, we don't know how everyone is going to process this trauma and how people are going to grieve. So it's really on every individual basis. How do we really process what we've been through and move forward in a healthy way? versus our some of us perhaps pushing things down ignoring things and not finding the support that we need? To understand what We've been through and where we want to go next. And when we think about young people how old they are, and where they are at their stage of development will play a role in how much they really understood about what was going on, and what their takeaways might be. And then how they manifest trauma, or any sort of anxiety or depression. So kids are all very different. Some may show nervousness and anxiety and avoidance. Others may have anger, outbursts, behavior changes. So there's really no one size fits all, Evan, when we think about how trauma impacts and also how trauma shows up in our lives, and how we show up around others.
Evan Sweeney
And to your earlier point, it sounds like that requires many different solutions. What solutions are out there currently, what sort of gaining traction, what do you find promising, that's an effective way to address the myriad of of things that we're seeing now.
Yusra Benhalim
So what we've seen is a lot of excitement and innovation in the digital space. And we've seen a lot of investment coming from people in places really outside of medicine and outside of behavioral health, at rates that we've never seen before and billions of dollars. And with that comes risk, because now we have families and children who are trying to get the right care and support that they need. And typically would have just connected with a doctor or a therapist, someone in the health care system. But instead, they're being marketed to now directly from these innovators. So patients have sort of become consumers. And so one of the ways that we're trying to ensure that whatever, a patient sort of connects with a solution, we make sure that it's sound, that it is going to work for them, and that it might actually be the best fit for them. So how do we do that, we think about the ways in which we can get the right information out. So knowledge is power. So thinking about ways that we can help families know more about the right solutions, and be able to make the best informed decision because they really are the experts on their child and their family. They know what might work better than one thing or the other based on how much they know their child. The other thing is that, in addition to sort of just giving them the information, and helping them not have to go to Google, right, is that we want to connect with them to help them navigate the journey. So in addition to sort of opening the doors and windows to knowing what's out there, ensuring it's evidence based, we want to also be able to support them in making all of the decisions as they move forward. Because their needs will change, the needs of their children will change. And it's not just a one stop shop, where it's a one size fits all, and it will cure everything indefinitely. We want to be able to make relationships with people so that they can come to us as a trusted source of accurate information, and a trusted source of evidence based solutions. So one way we're doing that is with our Family Support Program. This is where we have a team of experts who really work closely with a family so that they and their child are at the center of all the decision making. And we help them navigate. We help them create a roadmap, create their goals, and think about not only helping them in the here and now but thinking about preventing a crisis and enhancing their resiliency, and the well being of their child. We see so many families bringing their children to emergency rooms and hospitals, because they tried a solution and it didn't work, or they just didn't know where to start. So we think about really meeting people where they are in their homes in their communities. We think about the advantage of digital solutions and virtual connections, and helping support families and taking that first step to improve the here and now and all the while also thinking about prevention for the future.
Evan Sweeney
What are some of the things that Optum has put in place either recently, or over the last several years that that have you particularly excited?
Yusra Benhalim
So I'm excited I get excited about how we are all coming together. When we have our clinical team, our product team, our marketing team, we're all coming together to embrace the change within the behavioral health landscape and lead with clinically informed thought leadership. So we are staying creative and open minded. And we're also thinking critically about all the checks and balances that we want to build as new solutions are being developed. So we have a very a well established clinical vetting process where when we learn of a new app, when we have a provider or a vendor who approaches us who wants to be able to pitch a service to one of our members, we all come together, and we do our due diligence to have all the checks and balances in place to make sure. Number one, is this something that is going to work? And why? And do we think this is something that our members would benefit from. And so we are evolving. And I think it's a fascinating time to be in the space, because it's no longer just clinicians kind of working in their area, and product and innovators and technology and marketing working in their area. The shift from the pandemic has really created an atmosphere where we're getting thought leaders to work synergistically in real time. And I think that sets us up to be able to build and deliver solutions that we unlikely would have before pandemic times.
Evan Sweeney
You know, one other thing that I think we've seen in the research is that kids who need access to mental health services are not necessarily getting them. Why is that historically and sort of what's being done to address that issue?
Yusra Benhalim
We started off by talking today about the increase in the demand, really outpacing the supply. The question that you asked, I think is very important, because there's no doubt that there is a big group of our population that we don't even know needs us. So we're talking about the demand and the sense of people who are raising their hand and asking for help. What about all the people who are suffering and struggling and don't even know it, or don't know how to raise their hand? There's a lot of reasons for that, Evan, I think we have reduced stigma in the behavioral health space. With more of the national attention to mental health, we see stigma continue to decline. But that doesn't mean that all stigma has gone away. When we think about race, and ethnicity and culture. When we think about the social determinants or drivers of health, we think about disparities and inequities, there are still so many factors in place that would stop someone from raising their hand, or make it harder for them to get the help they need. When they do take that first step. And so we are very well aware of the group of people that we don't even know about yet. And we're thinking critically about ways that we can message to them, we can continue to break the stigma in those spaces, and break the barriers to them being able to get the care that they need. That's equitable, that's evidence based, I never take it for granted that we are in this incredible opportunity where we live and breathe behavioral health, we live and breathe, this mission of making the healthcare system work better for all but we hold ourselves accountable, that a lot of people still don't have access to equitable evidence based care.
Evan Sweeney
You know, that's an interesting point, when you describe that, it strikes me the impact on for mental health on a child is a little different, or substantially different than the impact of mental health on an adult, a child, obviously, as parents and teachers and sort of a support system around them adult, you know, maybe more independent. So I guess with that said, What would you say to parents, caregivers, who are looking for ways to help their child who may be in need of some type of service,
Yusra Benhalim
the first thing I would tell them is, you're not alone. And whatever your hesitancy might be your fears, your thoughts about why you shouldn't reach out, to put those to the side. And just know that in this moment of courage, I would want you to say I, even if I don't know where to start, I'm going to raise my hand for my child, because you are not alone. And a lot of people are in that position. I would also say to trust your gut, because you're the expert on your child. So if in any moment you feel like something is different, and something is not right, to listen to your gut, and to take action, because it's much better if you're able to reach out as early as possible, even if there is no problem and we find out that your child is doing really well and it's nothing to be concerned about. But then we have no regrets that we missed an opportunity. So many times when I work with families. A caregiver will tell me you know, I saw something I felt something a long time ago and I just thought maybe it would go away on its own or I thought it was no big deal. And then we find ourselves in a crisis. So it comes down to kind of seven, once you make the decision that it's better to go ahead and give it a try, who would you connect with? I think one support system is primary care. So when you think about family practice doctors or pediatricians to be able to kind of start that conversation with your child's provider, and let them know what your concerns are, and after the discussion to sort of come up with a game plan, like so what is what are the next steps as a caregiver? How are they going to support you and maybe exploring a little bit more? And then what's the game plan as far as when you're going to regroup? So let's say for example, they are your on ramp to connect with a therapist, they can help you find the right resources, they may not be. So they may say, Well, it might be best to go ahead and call your insurance, and see how your benefits would give you coverage for therapy and who is in your network. Even if they refer you to your insurance, I would encourage a caregiver to still come up with a plan with their pediatrician to say, okay, but when can we come back and regroup on what I was able to do and how my child is doing to have that extra layer of support? I think I would also encourage them to call us to call their insurance plan. And I know it might sound really weird, Evan, you know, why would I call my insurance. I think people don't know how much a managed care organization is here to really serve them, especially here where we sit, is that I would encourage any caregiver to give us a call, and just spend some time talking to us about your concerns, and be open to collaborating with us on building that roadmap with you and getting you connected to the right supports. We have an incredible team of talented clinicians and experts who know how to connect families with resources, and help them and their child get to those on ramps as soon as possible, especially now when we're building more on ramps that are easy to use. And they connect people with way more solutions that work then again we ever had before when we think about traditional and non traditional support and treatment options.
Evan Sweeney
Great. Well, Dr. Benhalim, thank you so much for coming down to talk about this important topic.
Yusra Benhalim
Thank you, Evan. And thank you everyone who's taking the time to listen, I think there's one thing I might leave with you is that we can all make a difference. So no matter where you may sit in your day to day life, no matter if you have children or not. I would be so grateful for your advocacy. If we all do this together. I think we can really move mountains and make the future very different in a much better way, not only for our youth but also for all of our families.
Evan Sweeney
Great, optimistic way to leave it. Thank you very much.
Yusra Benhalim
Thank you.
Evan Sweeney
That's it for this week's episode. Thanks to Dr. Benhalim for joining and thanks to you for listening. Have a great rest of your week.