It’s critical to acknowledge the efforts of those who’ve advocated for the integration of mental health care into primary care settings, a change that’s been nothing short of transformative. But as we face an ongoing mental health epidemic, it’s equally as important to recognize that this vital work isn’t over. The need for innovation and enhanced access to care remains urgent.
This urgency fuels the work of Dr. Gregory Harris who, from his roots in primary care to his pivotal role as Senior Medical Director for Behavioral Health at Blue Cross Blue Shield of Massachusetts, has championed efforts to advance integrated primary and home care practices.
He recently joined NOCD to delve into the evolving landscape of mental and behavioral healthcare, highlighting the role of specialized interventions, such as ERP therapy for OCD, in addressing individuals’ unique needs. As we navigate these insights, Dr. Harris paints an optimistic picture of the future, grounded in the growing awareness that mental health is an integral part of overall healthcare—a sentiment that’s gaining traction.
Tell us how you’ve helped advance integrated primary and home care practices since beginning your career.
I started my career in primary care settings, became a chief resident in primary care psychiatry, and worked in an integrated system at Beth Israel. Integrated health is where my heart is. I’m a big believer in that model. I think a lot can be done when mental health care can be accessed in a primary care setting, and that has driven my efforts throughout my career.
A presentation you gave in 2021 stated that 40.9% of people surveyed reported having a mental or behavioral health condition. Where does that figure sit now, and what can we infer from it?
There was a mental health epidemic before the pandemic, but the pandemic accelerated things, and that figure hasn’t gone down. Overdose and suicide rates are still increasing—the worst possible outcomes. The demand and the need for mental health care remain high. At Blue Cross, we’ve expanded what we’re doing on the health plan side and doubled our spending on mental health treatments. In terms of access to care, we’ve worked to reduce barriers and create opportunities for our members to seek and receive the care they need.
How does mental healthcare need to change to keep pace with the uptick in people having mental or behavioral health problems? And what role does increasing access to condition-specific treatment, such as ERP therapy for OCD, play in that change?
I’ve often described our Blue Cross network as broad, deep, and decentralized. Decentralization is part of the problem, as it results in mental and behavioral care being somewhat dis-intermediated from general medical care. In response to this, we’ve expanded our network—an ongoing initiative we’ve been working on for a long time. One key area of expansion has been the integration of mental health into primary care—a psychiatric collaborative care model, which is near and dear to my heart. The idea is that anyone can be screened in a primary care setting, and treatment can begin there.
When I started out in an integrated primary care setting, that approach wasn’t the norm, but mental health screening and care have become more and more disintegrated from primary care in subsequent years. We’re seeing some reintegration in primary care now, but there’s still a need for greater optimization. If that can be achieved, a significant number of people will have their needs met without needing to go to a specialist.
We have two avenues to achieve this goal. The first is through generalists, or primary mental health groups, as we call them. They’re our primary approach, as they make it easy to access many therapists with diverse specializations. The other is through the subspecialty area, which brings us to NOCD.
NOCD is laser-focused on one particular condition. While OCD affects many people, historically, it’s been difficult to find appropriate treatment and people who specialize in delivering this care. Experts in exposure and response prevention (ERP) therapy, a gold standard treatment for OCD, aren’t easy to find in a general network and traditional modalities like general psychotherapy or cognitive-informed therapy are often ineffective for people with OCD.
Some specialists may say that they treat OCD, but it’s not their focus and, as a result, outcomes can be sub-optimal. It can be hard to differentiate who really specializes, but partnering with NOCD has helped us connect our members to the care they need.
What makes you feel optimistic about the future of mental and behavioral healthcare?
My optimism is based on the increased awareness and acceptance of the idea that mental health problems are actually general medical problems. There’s been this divide between the two, as if they’re different. That’s what drew me to practicing psychiatry in primary care settings in the first place—the idea that mental health is all part and parcel of the total care. We have a tagline that mental health is health, and I think there’s been more awareness of this among our members. Their mental health is top of mind. I don’t think it was that way seven years ago when I came here, so there’s been a shift.
A silver lining of the pandemic is that there’s more thinking about how we can do things differently and better. There’s a lot of good care out there, but we want to make the systems much more user-friendly and integrated with other things that people are doing. It’s an exciting time.
Have there been any challenges or limitations associated with using telehealth for mental and behavioral health services, particularly when treating conditions like OCD?
I used to say telehealth isn’t the thing; the “thing” is to visit with me, Dr. Greg Harris, with the main difference being that your visit is through the computer instead of at my office in Brookline.
The challenge is that telehealth is not always ideal. It’s not perfect for all conditions or in all circumstances. One con is that people can hide things more easily during telehealth visits. You can sometimes miss specific cues and certain data points. For example, you can’t smell alcohol on someone’s breath during a telehealth visit.
How has Blue Cross Blue Shield addressed these challenges?
During and in the wake of the pandemic, we started to think about which services telehealth is appropriate for. You may never get an appendectomy through telehealth, but it can be appropriate for psychotherapy.
We want to promote the right type of service for the right member at the right time. We’ve also worked with our members to discover whether they prefer telehealth, or an in-person visit.
OCD diagnosis and treatment are very well-suited to telehealth. Exposure and response prevention (ERP) therapy can be hard to do in an office setting.
It goes back to my home visits at the beginning of my career. They say a picture’s worth a thousand words; I sometimes felt that a home visit was worth a thousand pictures. You can better understand who someone is and how they live when you’re in their environment. You don’t always get that in the office. With ERP via telehealth, you’re with them in their world, and that’s what that treatment is based on.
