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Kukreja P, Saxena K, Santra S. Driving change: addressing America’s mental health crisis through the power of mobile clinics in underserved communities. HPHR. 2023;62. DOI: 10.54111/0001/JJJ10
Our nation confronts an escalating mental health crisis and we find ourselves at a critical crossroads of this crisis, which if not addressed could gain epidemic proportions. This paper proposes an innovative, timely and potentially game-changing strategy advocating for the use of Mobile Mental Health Clinics (MMHCs) to address mental health challenges in underserved communities. By augmenting the well-established benefits of mobile health clinics with the imperative of mental health, we propose a proactive and cost-effective model that brings mental health services directly to the patient’s doorstep. The paper details how we could employ cutting-edge technology, streamline patient intake, treatment, and monitoring and provide an efficient approach that’s adaptable to the rapidly evolving healthcare landscape. It also offers a detailed and comprehensive operating model for a MMHC, encompassing staffing, service provision, community engagement, and potential collaborations while addressing the challenges and solutions associated with implementing such a model.
The silent but steady surge of mental health challenges in the United States is approaching the severity of a pandemic. Unlike the more obvious onslaught of a viral pandemic such as COVID-19, the rise in mental health issues is often not noticed but, if left unchecked, risks snowballing into a pandemic level crisis potent enough to destabilize our already strained healthcare system.
Nonetheless, we see a beacon of hope in this escalating situation. By strategically focusing on underserved communities—typically the most impacted by these challenges—we can employ innovative solutions that strike at the root of these challenges. One such promising solution is Mobile Mental Health Clinics. This approach aims to bring mental health services to the patient’s doorstep, thus lowering the threshold to receive timely treatment in a cost-effective manner. This paper will present the broad architecture of this game-changing solution.
The concept of mobile health clinics is not new. There are over 2000 mobile health clinics currently operating in the US. Mobile clinics are well-recognized for their ability to improve access to health care, ameliorate health outcomes and reduce systemic health care costs, particularly in underserved communities.1
An increasing body of evidence suggests that these clinics can be a novel way of delivering mental health services. The Covid-19 pandemic was a large scale real-life experiment in delivering care via the mobile model and scaling this mental health is the next frontier that can be a impactful tool in helping address America’s healthcare crisis.2
In 2021, there were an estimated 58 Million adults aged 18 or older in the United States suffering from mental illness. This number represented 22.8% of all U.S. adults and is an increase from 2019, when approximately 51 million U.S. adults reported the same.3,4 This statistic and its impact is particularly pronounced for underserved communities. As per the Substance Abuse and Mental Health Services Administration (SAMSA), mental health is a debilitating cause of concern for around 6 Million African American adults in the US. More importantly, between 50-58% of African American adults get no treatment for Serious Mental Illness. Similarly, Hispanic adults report a higher prevalence of psychosocial stress. Patients in these under-represented groups are often less likely to seek and receive treatment services thus emphasizing the immediate need for interventions in this subset of the population.5,6
Multiple social, financial and systemic barriers constitute treatment hurdles when it comes to mental health. Social barriers often present themselves as social inequities and discrimination related to living conditions, neighborhood attributes and work environments 7,8,9 Finances or the lack thereof are a significant barrier to usage of mental health resources owing to underinsurance and high transportation costs to. Research indicates a direct link between transportation access and health care utilization in underserved communities whereby inadequate transportation can lead to significant disparities in health care access, for mental health services10 Systemic barriers for access to mental health services include a fragmental healthcare system as well as legal and policy specific barriers. Semansky and Koyanagi pointed out that while Medicaid is the largest payer of mental health services in the U.S., policy restrictions and variability across states can limit the extent and quality of services beneficiaries’ receive.11
To meet the requirements of patients in various communities, mobile mental health clinics provide a variety of services including comprehensive evaluations and assessments, individual counseling and psychotherapy, crisis intervention and support, group therapy, support group access, medication management, psychoeducational and preventative programs, as well as referrals and care coordination. The clinics offer a range of interventions that are customized to meet individual requirements, with the goal of assisting people in managing their symptoms, enhancing well-being, and linking them to the right community resources and services.
In order to combat the mental health epidemic in marginalized communities, mobile mental health clinics have arisen as a creative approach. These clinics provide improved accessibility, flexibility, involvement of the community, lowered stigma, and cost efficiency. Mobile mental health clinics efficiently reach disadvantaged groups such as rural communities, the homeless, and racial and ethnic minorities, improving their access to crucial mental health care.12 Mobile clinics are extremely adaptive to evolving needs since they can change their schedules and locations in response to community needs, ensuring individualized care that takes cultural and contextual considerations.3 Their emphasis on community engagement helps to lessen stigma, normalize help-seeking behaviors, and create welcoming environments.13 Further, mobile clinics help cut costs by lowering unnecessary hospital stays and ER visits.14
Therefore, by delivering accessible, individualized, and cost-effective therapy while fostering community integration and eliminating stigma, mobile mental health clinics offer a unique strategy to address the mental health issue in neglected communities. Additionally, they foster community integration and collaboration, while offering cost-effective solutions to address mental health disparities and promote well-being.
The mobile mental health clinic would leverage cutting edge technology to simplify and streamline the process of patient intake, triage and treatment and monitoring. Computerized Computer-based psychiatric assessment instruments will be used to administer intake questionnaires such as PHQ9 and GAD7 will be available electronically for screening patients. On the back end, this data would be into the patient’s Electronic Health Record to enable optimized diagnosis, treatment, and follow-up.15,16 Advances in AI, psychology, and various technologies promise a new mental health service model, ideal for deployment in mobile mental health clinics. This model would use human-computer interaction and algorithms for real-time physiological and emotional monitoring, aiding clinicians in delivering more effective mental health screening and counseling. Studies have shown AI’s potential in mental healthcare, with machine learning being used to answer mental health queries. As AI techniques evolve, they could help practitioners objectively redefine mental illnesses, detect them earlier, and tailor treatments based on unique individual characteristics.17,18 Another area of innovation is leveraging experience from similar organizations such as The Family Van, Boston, Project HOPE, California and Friendship Bench, Zimbabwe. Friendship Bench utilizes the culturally sensitive screening tool known as Shona Symptom Questionnaire (SSQ) to identify individuals with common mental disorders / culturally sensitive and inclusive. We believe that a tool similar to SSQ can be adapted for the underserved communities in the US identified earlier. As per CDC, African American and Hispanic individuals reported more frequent concerns about not having enough food, which can contribute to chronic stress and affect mental health.19.For adapting the SSQ tool to these communities, we will need to take these stressors and identify idioms of distress in these communities by conducting ethnographic and qualitative studies. The SSQs relatively short length and simplicity could make it a good fit for a mobile health clinic setting, where efficiency and flexibility are often key.
The day-to-day staffing of these clinics would be supported by health workers, social workers, social worker interns, psychiatric nurses and peer navigators. These platforms used will be telehealth and remote consultation. Community Health Workers (CHWs) are essential to the operation of mobile mental health clinics because they guarantee the provision of community-based care that is sensitive to cultural differences. They provide outreach, education, and support services as a link between the clinic and the community while improving communication between patients and mental health providers, increasing patient access to care, and fostering trust. 20 Further, employing CHWs enhances the cultural relevance and competence of services, improving engagement and results. Social workers are another crucial part of the mobile mental health clinic team. Under the proper guidance, interns can assist in the delivery of direct services such assessments, brief interventions, counseling, and case management. Social workers are skilled in coordinating care, conducting psychosocial assessments, and connecting people with neighborhood resources and providing meaningful care while addressing the socioeconomic determinants of mental health. 21 Peer navigators will serve as champions for their patients to help them navigate the complexities of the healthcare system with firsthand knowledge of mental health problems play an important role. They will support, uplift, and provide helpful advice to people looking for mental health treatment while offering empathy, understanding, and relatability by drawing on their own experiences, leading to improved engagement and lower stigma.22 Psychiatric nurses are important particularly when it comes to managing and overseeing prescriptions. Their expertise in psychiatric assessment, drug administration, and side-effect control supports the provision of all-encompassing care. Psychiatric nurses have the ability to conduct assessments, provide medication as necessary, and track patient compliance and response to therapy. Their knowledge improves mobile clinics’ ability to offer a variety of treatments and attend to the needs of patients who need pharmacological therapies.23
Mobile mental health clinics can further improve operational efficiency by collaborating closely with neighborhood services in order to promote a thorough and integrated approach to care. These could include pooling personnel resources by collaborating with neighborhood mental health groups or clinics, resulting in a more effective use of mental health specialists. Underserved communities can be better served by working with community-based organizations like section 8 housing providers. In addition, highlighting health literacy programs in the neighborhood helps lessen the stigma attached to mental health problems and foster a community that is more accepting and understanding.
As with any other solution, the Mobile Mental Health Clinic comes with its own set of challenges. These include funding and resources constraints, limited availability or operating hours, limited mobility, lack of awareness about the mobile mental health clinic services, stigma and mental health literacy, operating over weekend, then triage to services to be used during the work week to name a few.
Mobile health clinics are an innovative solution to the burgeoning mental health crisis. By delivering swift, efficient, and targeted support to the populations most in need, we can make a significant difference. This innovative solution would not just save time and reduce healthcare costs but also address healthcare disparities and set the foundation for a healthier, more equitable and mentally healthy nation. We’re at a critical juncture where every decision, every action counts
We declare that none of the authors have any personal, commercial, or financial interests that could influence or bias the research findings and opinions presented in this manuscript.
Preet Kukreja, MBA, MHA is the director of Population Health Initiatives at St. John’s Episcopal Hospital and an expert in public health with extensive experience in project and grant-implementation, evaluation and sustainability. She serves as a co-chair of the Program Committee at Healthcare Innovation and Lean Network of New York that brings together Lean and innovation practitioners in healthcare facilities across the state. She also serves as a Judge for the SIIA CODiE Awards, American Best in Business Awards, Globee Leadership Awards and Golden Bridge Awards that honors top companies, products and people as leaders in innovation and excellence. She has also served as an abstract reviewer for the American Public Health Association (APHA) 2023 Annual Meeting & Expo. She is also a certified emergency response team member with New York City Office of Emergency Management which not only prepared her for any emergency situation but also equipped her with the ability to assist the community in times of crisis.
She has been instrumental in implementation of the public health programs and grants to address pandemic-COVID-19, public health emergencies-Mpox and health needs of the communities – Cancer, Obesity, Hypertension, Diabetes, Substance Use and HIV among others. Preet was instrumental in building partnerships with the NYC Department of Health and Mental Hygiene, churches, schools, community-based organizations, and congregations to address the health disparities prevalent in the Far Rockaway community. During the pandemic, she has secured grants through NYC DOHMH which led to expansion of access to care and improved COVID-19 vaccination rate in the community. She is passionate about serving underserved, medically marginalized and vulnerable communities through implementation of programs in addressing health disparities such as medical transportation, improving access to care, providing preventative screenings and point of care testing, health education, nutritional counseling, health-related resources, and improving vaccination rates. She has received acknowledgement and a certificate from NYC DOHMH for playing a prominent role in advancing health equity and preventing COVID-19 in NYC through Public Health Corps.
Her work has been recognized by the NYC Department of Health and Mental Hygiene through the acknowledgement of her role in advancing health equity and preventing COVID-19 in NYC through the Public Health Corps. She has been recognized as one of the Top 25 Emerging Leaders by Modern Healthcare for significant contributions to the culture of innovation and transformation in the field of healthcare. She is also a winner of the Boston Congress of Public Health – Health Innovator to Watch Award 2023 for health and healthcare innovation in the traditional public health field. She is also a winner of Stevie Award 2023 for Achievement in Management – Health Products & Services category. She has also been awarded with the International Achiever’s Award for her outstanding achievements and contributions towards nation building. She has been recognized as the Alum of the Month (May) by Hofstra University for making outstanding contributions in the field of public health. Her programs have received notable recognition such as the Food Security Program, which received membership spotlight on the Healthcare Association of NYS (HANYS) platform and the Mobile Health Outreach Program, which was nominated for a Community Health Improvement Award through HANYS.
Preet has received her MBA in India, Masters in Health Administration from Hofstra University and is currently pursuing Master’s in Public Health from CUNY School of Public Health. She is a Lean green belt and six sigma white belt certified. She hold certification in DOHMH led training in HIV, HEP-C, STI, PEP, PREP & Other Biomedical Interventions, Best Practices in PEP & PrEP Education & Counseling, HIV Stigma, LGBTQIA+ Primer, HIV Rapid Testing, Linkage to Medical Care, Undetectable=Untransmittable and & Hepatitis C Patient Navigation. She is a member of the New York Academy of Medicine, Healthcare Association of New York State, American College of Health Executives, Healthcare leader of New York, American Public Health Association, and New York State Public Health Association.
She can be reached via email at [email protected]. You can also find her on LinkedIn at www.linkedin.com/in/preetkukreja.
Kinshuk Saxena, a distinguished expert in the life sciences and healthcare sector, currently holds a pivotal role as part of the Internal Strategy group at Novartis. Throughout his illustrious career, Kinshuk has demonstrated unparalleled expertise in strategy development and execution across a spectrum of pharmaceutical and medical technology organizations. Prior to his tenure at Novartis, Kinshuk led transformative initiatives, advised executive leadership teams, and drove digital transformations in his roles at Strategy& and IQVIA Consulting.
In his current position at Novartis, Kinshuk steers key strategic initiatives and transformations, working closely with the Executive Leadership Team. His leadership has been instrumental in developing business case briefs, designing and delivering operating models, spearheading oncology operating model transformation, and leading the Intellectual Property and Strategic Transactions (IPST) and Budgeting workstreams.
Before Novartis, as an Engagement Manager at Strategy&, Kinshuk led the development of a “Reimagine Primary Care” strategy as part of a digital transformation effort. His work at IQVIA Consulting involved leading international project teams on a wide range of assignments, including market analytics, due-diligence, portfolio optimization, launch strategy, market access, patient journeys, clinical development transformation, and regulatory strategy.
Kinshuk holds an MBA from Rutgers Business School, where he was a two-time winner of the Biopharmaceutical Case Competition. He also holds a Doctorate of Pharmacy from Manipal University. Earlier in his career, Kinshuk formulated regulatory strategies, managing the submission and approval of Phase 2/3 oncology products while laying the groundwork for breakthrough therapy designation. He was recognized by the CEO for his work in the development and commercialization of an orthopedic medical device.
A dynamic speaker and thought leader, Kinshuk is frequently invited to speak at multiple life science conferences. His contributions extend beyond his professional roles, as he actively engages in podcasting on life-science and healthcare topics. When he’s not shaping the future of healthcare, Kinshuk enjoys spending quality time outdoors with his family.
As the Director and Head of Business Insights and Strategy at Chugai Pharmaceuticals, Snigdha Santra leads with a clear purpose: to bring unique, patient centric clinical insights into early drug development and strengthen partnerships in the drug development continuum, ultimately aiming to have a transformational impact on human health.
Over the course of her diverse career spanning more than a decade, Snigdha has held several senior positions across a variety of markets and disciplines, from leading payer analytics at Wunderman Health to multiple commercial leadership roles at Novartis Pharmaceuticals. Her experience working with international teams and managing cross-functional collaborations has enriched her understanding of the global healthcare landscape, further fueling her commitment to ensure equitable access to medicines.
At Chugai Pharmaceuticals, Snigdha has lead insights generation for early-stage products in rare diseases. She has fostered a culture of innovation, courage, and excellence within her team, driving them to become more science-driven and research-oriented. This focus on innovation has led to the start of multiple patient centered engagements within the organization.
One of Snigdha’s most notable achievements is her work with patient advisory groups in rare diseases and diseases with high unmet need. Her dedication and relentless efforts have led to the development of resources to support patient education – an accomplishment that echoes the company’s commitment to improving patient outcomes.
In addition to her role at Chugai, Snigdha also upholds her commitment to social responsibility. As a former Lead Health Columnist for Impakter, an online magazine, she contributed to global health discussions that help shape the discourse in her field.
Snigdha holds a Master’s in Public Health with a focus on Health Policy and Management from Columbia University, New York and a Master of Clinical Pharmacy from Manipal University, India. In recognition of her leadership and contributions to the field, she has received several awards including Most Valuable Player at Wunderman Health and the Chugai Awards for Product Lifecycle Innovation from 2019-2022.
In her various roles, Snigdha remains a member of the global healthcare community, dedicated to improving patient outcomes and advocating for equitable access to medicines. Her leadership and commitment to innovation continue to inspire her colleagues and others in her field.
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