Executive summary

We have created a mental health navigator pilot program that you can sign up for at https://eamentalhealth.wixsite.com/navigator

Overview

Out of the 191 respondents to the 2018 EA Mental Health Survey who reported needing mental health care, 48% said they are not receiving the mental health care they need. 30% of the 303 total respondents believe that they could personally benefit from an EA mental health care navigator. To help improve EA community mental health, we propose creating a mental health care navigator program.

The mental health care navigator will

1. Direct EA members to local and online mental health resources
2. Collaborate with EA members to create mental health improvement action plans
3. Help members navigate insurance options
4. Create EA mental health informational resources and workshops for local groups
5. Research the mental health care systems and available resources in locations where EA members live

The navigator will first dedicate about two weeks to familiarizing themselves with resources available in highly-concentrated EA areas. They will then work directly with EA members online, over the phone/video chat, and in-person. The navigator will listen to the member’s mental health situation and ask questions to gain a deeper understanding of the member’s barriers to care access. The navigator will then describe various local and online options and answer the member’s questions, doing more research as needed. The two will work together to create an action plan and discuss short and long-term goals. The navigator will follow up and provide support throughout the member’s mental health care journey.

Potential areas of counsel

• Compare mental health care provider and insurance options
• Advise on how to obtain health insurance
• Overcoming the obstacles of cost and availability of care
• Refer clients to local services that offer free and/or immediate counseling
• Inform clients of online or over-the-phone services
• Discuss who can prescribe medication and how to refill prescriptions
• Compare different approaches to therapy/counseling
• Direct clients to providers recommended in the EA community
• Recommend programs for specific conditions
• Advice on switching providers

THE NEED: BARRIERS TO ACCESS

Information

People seeking mental health care often struggle to determine what mental health resources are available. Out of the 300 respondents 2018 EA Mental Health Survey, 38% said it was moderately to very hard to find useful information on mental health care services. This result reflects large-scale trends. A Cohen Veterans Network and National Council for Behavioral Health 2018 survey found that 1 in 3 Americans did not seek treatment for themselves or a loved one due to not knowing where to look. A study of 2785 college students found that 37% to 84% of students with positive screens for depression or anxiety did not receive any services largely due to unawareness of services and insurance options. The complexity of navigating health care systems is exacerbated by the fact that researching options is much more difficult when one is struggling with mental illness.

The navigator will be a central source of information for EA members who are struggling to find useful information and/or for whom mental health challenges are making it near impossible to dedicate hours of effort to navigating the system.

Cost

Mental health care cost is a significant access barrier. Out of the 300 respondents to the 2018 EA Mental Health Survey, 21% said they sometimes or regularly experienced financial difficulties as a result of mental health care. In a 2018 study on access to mental health care in the United States, 1 in 4 respondents reported having to choose between receiving mental health care and paying for basic necessities. A 2017 study found similar results: About 27% of respondents reported declining mental health care due to expense concerns.

Many free or reduced-cost resources exist, but are not well-known. This is especially true in larger cities where many EA members live. The navigator would connect members to these services when possible. In the absence of affordable local services, the navigator would refer members to free or more affordable online resources, or potential funding sources.

High demand

A substantial barrier preventing people from accessing mental health care services is high demand. In the US, more than one in three people who seek immediate in-person care have to wait longer than one week. Wait times can be months long in several countries in Europe, including England and Germany. Nearly half of all Americans report personally having to drive more than an hour for a mental health care appointment or knowing someone who does. Long wait times can have a detrimental effect not just in the short-term, but also on outcomes twelve months later after care has been received.

The navigator can help alleviate the problem of high demand in two ways. First, there may be available local resources that are not well-known. The navigator can connect members with these resources. Second, if demand for local resources is too high, the navigator can connect members with online and over-the-phone resources.

PROGRAM DETAILS

Role

1. Become familiar with resources in highly-concentrated EA areas including San Francisco, Oxford, Boston, Berlin and London
2. Help EA members create action plans to improve their mental health
3. Act as a liaison between the EA community and providers
4. Provide resources on mental health to the global community. These could include books, exercises/workshops, articles, and informational pamphlets specific to a local group’s needs and available resources.

Hours

We propose piloting the program with a five-hour per week volunteer commitment to determine its effectiveness before investing in a full-time position.

Initially, about half of the navigator’s time will be spent researching health care and insurance options and building relationships with providers in high EA-concentrated areas. The other half of their time will be dedicated to working directly with EA members. This ratio will eventually move towards 1:3 as the navigator becomes more familiar with resources.

Finding clients

The MH navigator will maintain a website with a form and contact information. They will advertise their services in the EA newsletter, FB groups, SSC, and other EA outlets.

Consultation process

1. Listen. Explore the member’s situation together using active listening techniques. Assess the member's needs and challenges to having those needs met. Discuss what has been tried in the past. What has helped and what hasn’t? What have been barriers to access?
2. Discuss short-term and long-term measurable mental health goals.
3. Brainstorm options. The navigator provides information on local and global resources. These may include in-person therapy, online therapy, medication, informational resources, comprehensive lifestyle plans, etc. If relevant, they will discuss insurance options.
4. Create a step-by-step plan with the client.
5. Follow up. Check in with the client on a weekly basis to evaluate how the plan is working. Does anything need to be adjusted? Are there new needs that may not have been present before?

Research and resource maintenance

The navigator will research available resources, focusing on EA-dense areas. They will research additional areas in which clients live prior to their initial consultation.

PROJECTIONS AND IMPACT MEASUREMENT

Evidence from health care navigator programs

Studies on health care navigator programs show promising results. A Mental Health Care Navigator program in Canada provided assessments, service planning, and referral facilitation, and served as information providers to about 300 people. Seventy percent of their clients were connected with the services the navigator referred them to by the time of follow-up. Narrative data indicated that this service increased understanding of available resources among people seeking treatment and created a more comprehensive network of care. An Australian mental health navigation service’s 2018 review indicated that over half of their clients saw significant reductions in anxiety, stress, and depression symptoms.

People with peer support tend to have higher access to care than those with support from medical professionals alone: A community-based support role increases people’s likelihood to seek out and receive primary care. In a review of 12 papers on the results of lay-person general health care navigator models, patients experienced improved general wellness, reduced financial stresses, increased employment, improved knowledge and skills, and reduction in emergency room or hospital use. A meta-analysis of 25 randomized controlled trials on patient navigation models found similar results: Overall, patients with peer navigator support were 2.5 times more likely to receive health screenings.

Improved well-being through access to care

You can read our Guesstimate model for projected impact here.

Increased productivity

To best help others, we need to prioritize taking care of ourselves.

The mental health care navigator program is expected to have spillover effects in productivity. Among survey respondents, on average, about 1.25 hours of work were lost per week due to mental health struggles. (This totaled about 1,758 hours of work in the two weeks prior to the survey.) This number almost doubled among those diagnosed with a mental health condition to 2.2 hours of work lost per week. Sticking with the statistics for respondents overall, if the mental health care navigator helps five people in one week locate the services they need, this would result in about 6.25 additional hours of work enabled for each week that the members they help receive support. Many EA members who are expected to utilize the navigator services will likely contribute to top case areas through direct work and by earning to give.

Importantly, we also expect clients’ motivation, enjoyment, and quality of work to improve as a result of gaining access to care. Mental health challenges make it difficult to focus, problem solve, and think creatively. We expect that connecting members with the services they need will improve work quality as a result of an increase in overall well-being.

Measuring impact

We will use pre and post-consultation mental health surveys to measure the self-reported impact of the navigator program. Additionally, in the post-consultation survey, we will encourage clients to give feedback on the navigator's help. This will include ranking the utility of the information provided, the approachability of the navigator, and whether or not the EA member would reach out to the navigator again.

MEET DANICA

I graduated from Whitman College with a B.A. in Psychology. In college, I trained students in active listening techniques and crisis management as a leader of a college counseling center group called Peer Listeners. I later interned for an organization called The STAR Project that connects people recently released from prison to services that promote successful community re-entry. With the help of Nuño Sempere, Jaime Sevilla, and EA Spain, I designed and conducted the 2019 EA Mental Health Survey to gain a better understanding of mental health in the EA community. Last year, I attended and presented at an EA Mental Health Conference in the Netherlands where we brainstormed ways to support member well-being. I have recently completed Mental Health First Aid training and suicide prevention training in preparation for the Navigator pilot. I value authentic communication and believe I can combine empathic care and creative problem solving to help connect EA members with beneficial resources to promote their mental health.

I AM NOT A LICENSED PSYCHOLOGIST. My role is to help connect you with professional resources. 

NEXT STEPS

You can now sign up for the pilot version of this program at eamentalhealth.wixsite.com/navigator

Results of the pilot program will be published in ~6 months. If impact measures indicate that the navigator program is a worthy investment, we recommend creating a full-time Mental Health Care Navigator position.