Innovative solutions for the growing mental health crisis in children and families [PODCAST]

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Join Monika Roots, a child and adolescent psychiatrist and health care executive, who explores the concerning rise in diagnoses of depression, anxiety, and behavioral problems, the shortcomings of the current mental health care model, and the potential solutions. Discover how technology, early intervention, care coordination, equity, and policy changes can reshape mental health care for the better. Don’t miss this critical conversation to help our children and families thrive.

Monika Roots is a psychiatrist and health care executive.

She discusses the KevinMD article, “Urgent innovation is needed to address the growing mental health crisis among children and families.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Get CME for this episode by clicking on the CME link in the show notes. Today we welcome Monika Roots. She’s a psychiatrist and health care executive. Her KevinMD article is titled “Urgent innovation is needed to address the growing mental health crisis among children and families.” Monika, welcome to the show.

Monika Roots: Thank you for having me.

Kevin Pho: So we’ll get into your article in a little bit. First off, briefly share your story and journey to where you are today.

Monika Roots: Yeah, so I am a double board-certified child, adolescent, and adult psychiatrist. I’ve been working in virtual care for a very long time, but my career started in child protection, in-person care, substance use, and eating disorders, the really complex issues. I went on to create a company called CogCubed that was focused on quantifying behavioral health using games for kids to better address and assess for ADHD, anxiety, and depression. That went on to sell to Teladoc, and I became VP of health services there for four years, overseeing clinical quality and services across the online business.

Then I went on to be chief medical officer of Sanvello, which is a full-stack solution for adult mental health care focused on content, coaching, therapy, and psychiatry. But in all of that, I wasn’t able to really focus on kids and teens in the virtual setting, and so in 2021 I co-founded Bend Health, which is focused on kids, teens, and families and their mental health care.

Kevin Pho: So talk about your dual role as a psychiatrist and a health care executive, founder of many companies. Talk about that transition.

Monika Roots: It’s interesting, in that when I was in my training and in the beginning of my experience as a clinician in person, I saw a lot of gaps and a lot of need. I saw situations where kids would be dragged into the office by their parents, and there was a lot of acting out, and it was hard to really figure out what was going on. Because we couldn’t do that, they would end up on my inpatient unit, and we were kind of playing catch-up.

So over time, it really became very obvious to me that we need to start thinking outside the box. That led me to start really working in the digital tech and health tech startup world, where we can look at transitioning many of the things that we learned in school into new solutions, things that are technology-enhanced services, so that we can address a significant need that’s out there, especially for kids and teens.

But obviously I’m a clinician at heart. I’m a child psychiatrist, so I’m always thinking about the member, or the child and the teen, but also from the clinician standpoint. And so I always feel like I bring that lens to all of the digital health care startups that I’ve worked at, which is that it’s not just about the patient, and it’s not just about the clinician. It’s about the ecosystem.

Kevin Pho: Now, before transitioning into that startup world, did you have any business training? What kind of background did you have to make that transition smooth, or was it smooth?

Monika Roots: Oh, it was not smooth. I have an MD by background. I trained in psychology as a pre-med and went on to be a doctor. I did not have an MBA, so a lot of this was training in-house, on the job. But I think that much of learning the business of digital health care is really listening, connecting with others who are in the field, understanding their knowledge, and then improving on it. And trust me, there’s a lot of learning no matter what degree you have, especially in this area.

Kevin Pho: All right, let’s talk about your KevinMD article titled “Urgent innovation is needed to address the growing mental health crisis among children and families.” Now, how did your article come together?

Monika Roots: I’ve been thinking especially about kids, teens, and their families. It is an exploding area of need. If I had known, maybe I would have created Bend earlier. But the reason is that there are so many things that we need to do in the health care aspect to really help with the growing need in mental health. And so as I was putting this article together, I think about it as: What are the factors we really need to look at as levers so we can better address this mental health crisis we’re facing?

Kevin Pho: So give us some statistics or stories, just to give some context before we talk about some opportunities.

Monika Roots: Well, as a clinician myself, I have treated a lot of kids over time. Many of the stories that really resonate and come to mind are about those who come to me, for example, who may have been on a lot of medications, and they have a lot of providers, but they’re not talking. There are a lot of medications going on that have side effects. There are a lot of services, but maybe not coordinated, and no one really knows if people are getting better.

So that’s kind of what led into my article and into thinking about what the pieces are that really need to be modified to get better. Part of that, I think, is around technology. I think it’s around prevention. So this child who came to me on multiple medications with multiple diagnoses: What could we have done earlier? What could we have done better? How could we have collaborated? Many specialists involved in someone’s care doesn’t mean that they’re all talking. That’s kind of sad, right? If we collaborated and talked, maybe this child would have gotten different services or more attention in a certain area, and maybe less medication or better interventions.

And then I really think about the system in general, in terms of mental health being health in general. Sometimes we leave that second and not first when we address issues in kids, teens, and families. So those are just some of the small things that I thought about for this article. But then, of course, there are larger issues, such as the health care payment environments and the financial and revenue models that exist. What can we do in that arena so that we continue to focus on the quality and outcomes of care, not just how many people we can see in a day?

Kevin Pho: So you’re in the health tech space. What kind of innovative solutions are being floated around in terms of addressing this issue?

Monika Roots: Well, I think there’s a lot of technology. For example, we’ve seen telehealth platforms that can beam your clinician into the space of your living room. We have seen content, so people can learn skills on their own. But now we’re seeing more than that. We’re seeing additional touch points. We’re seeing data being transformed into recommendations, so that we as clinicians can really understand where a person’s coming from. And then, of course, we have the new things out there, like chatbots and ChatGPT, a completely new forum that we’re going into with maybe not a lot of oversight and regulatory insight into what it is. So technology is there, and there are a lot of facets to it, maybe good or bad, but that’s exploding, as we know.

The other piece I think we’re seeing now is a really strong focus, especially on the medical side, on value, which I’m really excited about. When I talked to kids, especially in the beginning, people would come to me, and I used these inventories like PHQ-9s and GAD-7s to assess for depression and anxiety. But many of them would come to me and say, “Hey, I’ve been in therapy for years.” And I would say, “Well, how’s it going?” “Well, I think OK.” “Have you ever had any assessments to see how it’s going?” “No.”

So this has been an arena, the mental health field, where we have not measured a lot, and we have a lot of room there to improve and really show the value of the care that we’re giving. So as we look at payment reform and at different revenue models that reward value, I think those are some really interesting nuances that we’re seeing in health care that can really promote better outcomes.

Kevin Pho: So you mentioned telehealth, virtual care, and chatbots. These are all things that can certainly help with access in terms of teen and adolescent mental health. So give us your ideal scenario. Let’s say you were in charge. In your ideal world, how would you see that interplay between these technological solutions and addressing this mental health issue?

Monika Roots: I believe in a hybrid approach, meaning that I don’t think there is one solution that fits all. So, for example, if an individual better accesses care through chat, or through asynchronous models, or learning on their own because that’s their learning style, that would be fantastic. Or coming at it from “Hey, this person doesn’t learn very well if they read materials, but they’re really good verbally,” if you can talk it out, well, that’s great as well. Now, do we think about those as the same? Well, potentially, if they result in the same outcome. So it’s really understanding that there are different technological modalities that actually might result in better outcomes and potentially need to be reimbursed the same way. And so I think that’s an important piece of it.

And then coordination: These things cannot happen in a bubble. And so even if we have great solutions that are virtual, they need to be able to connect home to the primary care environment. There needs to be a hub that really understands all of the interventions that they are getting, and coming together and collaborating, so we can think about each child, each teen, or each adult as really an ecosystem of care and a whole-body, whole-mind approach, because we need to think about the whole system.

And then, once again, coming at it earlier: How can we reach people in terms of prevention, so we’re not so reactive when it comes to mental health? How do we start talking about mental health in schools, in work environments, and in preventative skills, so that, once again, that child doesn’t end up on inpatient seeing me? I caught them much earlier.

Kevin Pho: So you mentioned outcomes. I know it’s relatively new in the field. Is there any data in terms of showing the efficacy of some of these platforms?

Monika Roots: So what we are seeing in this arena, I think, is that those who are measuring outcomes are surfacing as more of the solutions of choice. We see that for those that are measuring, for example, depression or anxiety or ADHD symptoms, and looking at both how they started in terms of severity and how they’re progressing, that results in the best treatment outcomes. We’re seeing that in the studies that are coming out, and I think that is leading into this concept of what we call value-based care, which is not just measurement. Measurement is a key feature of it, but what are the other value levers that we have? That might be coordination of care.

But it’s actually a very sad fact that up until now, only 17 percent of mental health providers have actually used it. And so that means that we have to create behavior change to be able to enhance and incorporate this more into practice. And so looking at what the incentives are for utilizing these measurements, and how we can educate our members, our patients, on the value of these, given it’s such a behavior change, is really important.

Kevin Pho: So tell us the state of things now. Like you said, pediatricians and primary care doctors are overwhelmed and may not have enough time in terms of being those behavioral health resources for the patients. What kind of options do they have to turn to today in the exam room? What would you recommend for them right now?

Monika Roots: I think one of the most innovative models is called collaborative care. It’s a form of care that’s been really well studied, with over 90 randomized controlled trials, where a psychiatric provider acts as a consultant to the primary care physician so that they can better address these mental health concerns and do interventions. The sad reality is that our pediatricians and psychiatrists have very little mental health training, yet because there are no solutions out there, they’re turning to medications. I don’t blame them. This is a crisis. Moms come in and want help for their teen, and sometimes a pill is the only thing they have. I get it.

So, turning toward this model of collaborative care, especially if we think about family systems and interventions, so we can address many of the family system issues that affect kids and teens, and even adults, and then utilizing the right medications. I say that and I emphasize that because sometimes mental health conditions show up as physical, or a mental health symptom might show up and it’s actually a physical problem, and a psychiatric provider is the best-educated expert to be able to sift that out. Because what we don’t want is a child, teen, or adult being in therapy for years when it’s actually a thyroid problem and we missed it.

So that is one thing they can turn to, as well as turning to other community providers to help them, as well as telehealth solutions. Yet I continue to emphasize that we cannot be referring to point solutions that don’t collaborate, because we will not get the outcomes we’re looking for.

Kevin Pho: How about from the patient’s side? Families are listening to you now, and they have children with behavioral health problems that are not being addressed. What kind of resources do you recommend for them?

Monika Roots: The first thing that I would turn to is understanding: Does the school have support? Or, if you’re employed, do you have any benefits that could really address kids and teens? And this is not simply just parent skills training. You need to find solutions that are built for kids and teens, not just an adult solution that we’re mapping onto a kid. What that means is interventions that speak in their language and really speak to their learning styles, and content for them that’s relevant, or therapy that is relevant.

So there are many things that they can then turn to, such as coaching. A lot of mental health care for kids is actually coaching. It’s around executive functioning skills, organizational skills, and stress management. Remember, early prevention is really important for kids and teens so it does not become a lifelong issue. And then, of course, they have therapy and psychiatry if necessary. Those can be delivered virtually or in person, or, once again, through this collaborative care model. So ask your pediatrician what you might have available to you.

Kevin Pho: We’re talking to Monika Roots. She is a psychiatrist and health care executive. Her KevinMD article is titled “Urgent innovation is needed to address the growing mental health crisis among children and families.” Monika, tell us some of your take-home messages that you want to leave with the KevinMD audience.

Monika Roots: My biggest take-home is that we need to look at new models that are really innovative and scalable to address this crisis. The ways that we’re going to do that are thinking about prevention. We’re going to have to think about new ways of addressing the issue, through content, through peer support, through coaching, not necessarily the old therapy that you would think about, which is in person in an office.

And then, furthermore, we really want to remember that family systems are important for kids and teens. So it’s not just about an intervention for a kid or teen; it’s the family system. Parents need to be involved. So there’s a lot of hope out there. There’s a lot of care that’s available, and I hope that people access it as soon as possible.

Kevin Pho: Monika, thank you so much for sharing your time and insight, and thanks again for being on the show.

Monika Roots: Thank you.

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