A Shift in Awareness

Over the past 5-10 years, behavioral health has finally emerged from the shadows. Once overlooked and stigmatized, mental health is now widely recognized as essential. The COVID-19 pandemic accelerated the push for accessible (tele) behavioral health solutions, and demand continues to rise even post-pandemic, indicating a permanent shift in societal attitudes.

However, this increased demand also drives up costs, creating pressure on payers to cut expenses while maintaining access to care. It’s a difficult task, but not impossible. The key is to focus on quality, outcomes, and innovation to both improve patient care and control costs.

Quality: Moving Beyond Access

For a long time, discussions about behavioral health focused almost exclusively on access, with little attention to the quality of care. Yet it’s essential to ask: Access to what? Is the care being delivered genuinely effective?

Recent articles highlight concerning trends. A 2023 Time article (“America Has Reached Peak Therapy. Why Is Our Mental Health Getting Worse?”) revealed a significant decline in mental healthcare quality from 2012 to 2020—raising the question: shouldn’t quality be improving, not deteriorating? Meanwhile, a 2023 New York Times piece (“Does Therapy Really Work? Let’s Unpack That.”) also questions the general efficacy of therapy.

If mental healthcare isn’t truly effective—if patients never reach symptom remission or show real improvement—then they’ll keep needing more care to address unresolved issues. This creates an ongoing demand for additional services in an effort to fix what wasn’t resolved before.

Measurement-based care can help address these concerns by systematically tracking the quality of services provided. Linking provider incentives to outcomes—a model often called value-based care—can further drive meaningful improvements. In practice, tools such as self-reported measures, patient satisfaction surveys, and session rating scales allow organizations to gauge whether care meets specific quality standards. However, beyond just measuring the quality of care, we also need to evaluate treatment outcomes and modalities—and determine how to improve them across the board.

Outcomes: The Mind and the Body Are Not Separate

Historically, mental health outcomes have received minimal attention, with relatively little effort invested in measuring treatment effectiveness. Some argue that mental health lacks standard biomarkers and is therefore too subjective to quantify. However, self-report scales, claims data, and emerging biomarker technologies (e.g., Kintsugi Health) suggest that meaningful measurement is both possible and beneficial.

Many believe mental health outcomes are “capped” because mainstream treatments—whether medication or therapy—haven’t significantly improved in decades. Traditional talk therapies like CBT have not shown a strong upward trend in efficacy over the last 20–30 years, and recent debates question whether antidepressants are much more effective than placebos. Ketamine typically provides only short-term relief, while psychedelics (e.g., psilocybin) appear promising but lack long-term data.

One major reason for these stagnant outcomes may be a narrow view of what drives mental health. It extends well beyond the mind or brain to include physical health, nutrition, exercise, sleep quality, and social determinants. Studies show that exercise alone can outperform medication in treating certain depressive symptoms. Conversely, poor diets filled with processed foods, nutrient deficiencies (e.g., vitamin D, B12, magnesium), and high stress—often tied to adverse social determinants—can significantly undermine mental well-being. Unfortunately, most mental health providers never address these underlying factors.

Innovation: Rethinking Mental Health Care

How can we move forward? Innovation can make a significant difference by thoughtfully implementing what we already know works. At Meru Health, where I serve as CEO & founder, we have completely rethought traditional care to demonstrate one potential path:

           1.         Custom Digital Infrastructure

We built our own electronic health records and monitoring systems. This allows us to track real-time data on patient acceptance rates, clinical outcomes, patient satisfaction, provider performance, and even documentation quality. We use these data internally to improve our care, quality and processes. We share these insights with our payer partners, enabling collaborative improvement.

           2.         Continuous, Programmatic Care

Instead of seeing patients only once a week or month, our providers connect with them an average of 25 times each month via calls, chat, SMS, and digital tools. Patients also engage with app-based learning materials, interactive practices, and peer support. This comprehensive approach means patients—sometimes even with severe depression or anxiety—receive around 15 hours of engagement over 2–3 months (vs. 2–3 hours through a typical EAP). The result is deeper learning and more lasting behavior changes. More frequent interaction with the patients also ensures we are able to intervene before things start spiraling down and as an example lead to an ER visit.

           3.         Holistic Mental Health Model

We address diet, potential nutrient deficiencies, exercise, sleep quality, and social connections. Our goal is complete symptom remission, not just short-term symptom management. Our peer-reviewed research with Stanford, Harvard, and others shows that this integrative approach yields outcomes roughly twice as effective as traditional talk therapy or medication.

Conclusion

Behavioral health is finally receiving the attention it deserves. By focusing on quality, using measurement-based care, tracking outcomes, and fostering innovation—especially through holistic, integrative approaches—we can offer patients more effective, longer-lasting support. The mind is not separate from the body, and understanding this interconnectedness is critical for achieving true breakthroughs in mental healthcare.

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