Mental health is a journey. Our system treats it like an appointment | Viewpoint

Mental health shaped my life long before it shaped my career.

I lost two family members to suicide. Their deaths were not out-of-nowhere events. They were the tragic endpoints of long, uneven struggles that unfolded over years. Their losses taught me something I would only fully understand later: mental health conditions aren’t episodic. They’re continuous.

After becoming a mother and experiencing perinatal anxiety and depression, I was surprised by how difficult it was to re-engage with care after I had been in therapy years before. As a leader helping shape how care is delivered at scale, I understood the system intimately. Yet even with that knowledge, navigating it required energy I didn’t have.

What ultimately made the difference was being able to reconnect with care when I needed it — during a period when my capacity to advocate for myself was limited.

The case for lifelong mental health care

My experience reinforced that mental health care isn’t built for the way these conditions actually unfold.

Research shows that conditions like depression and generalized anxiety disorder often follow long trajectories, with periods of remission and relapse spanning years or even decades.

Remaining engaged in treatment over decades is difficult, especially when the symptoms themselves interfere, and the system complicates it further. Forty percent of Americans live in areas with mental health professional shortages, and the average wait time to receive behavioral health services anywhere in the country is 48 days. And when the first provider isn’t the right fit or becomes unaffordable, patients may have to start over, repeating triggering intake forms and navigating administrative or insurance challenges. For many, the system actively gets in the way.

When care is designed as episodic, these periods of disengagement become periods of risk, often leading patients to forgo care or obtain crisis care through settings not designed for longitudinal support, like emergency departments.

Creating care plans for the reality of chronic care

Mental health care stands in contrast to how we manage other chronic health conditions. Patients with diabetes, cardiovascular disease, or cancer are not expected to manage their conditions alone after a discrete episode of treatment. Their care is longitudinal, with regular check-ins even during remission and care navigation built in as a standard of care.

Because mental illness is chronic and recurrent, care cannot be designed for isolated clinical encounters. Mental health is physical health, and it deserves the same model of care.

My family members’ mental health did not deteriorate overnight. Their struggles unfolded gradually, with warning signs that emerged over time. But the system was not designed to remain continuously connected to them. It was designed to respond when they actively sought care – and to remain passive when they did not.

This isn’t simply a clinical issue. It’s a structural one, with factors such as capped visit limits with insurance restrictions and provider shortages, which are expected to increase.

Further, ever evolving laws and regulations – from telehealth policy variability to cross-state licensing restrictions and more – don't always favor patients.

Access doesn't guarantee continuity

While we’ve made progress in expanding access to mental health care, access alone is insufficient.

Continuity is what protects patients during their most vulnerable periods. So, how can we redesign care to maintain connection with patients beyond the therapy room?

• Proactive presence: Rather than waiting for patients to seek care when they are already struggling, care systems must intelligently reach out. Use your EHR to flag known risk signals and identify patients who have disengaged for extended periods. Build automated outreach triggers at these times on the patient’s channel of choice.

• Always-on support: The surge in Generative AI use for emotional support tells us people are seeking a listening ear when traditional care is unavailable, unaffordable, or disproportionate to their needs. Embed low-acuity resources like self-guided coping exercises or therapeutic skills into tools patients already use, so they have somewhere trusted to turn between visits.

• Care escalation: Continuity depends on systems that can recognize early warning signals and seamlessly guide patients to the right level of care at the right time, without forcing them to start over or self-diagnose in moments of distress. Define thresholds that should automatically initiate a transition to the next level of care. Design care navigation that carries a patient’s medical history into the referred service.

• Redesigned reimbursement models: Chronic care models normalize maintenance, periodic check-ins, and support that begins in childhood and extends into adulthood. Mental health care payment models must evolve toward value-based designs that reward prevention, stability, and continuity – not just billable episodes.

As someone who has experienced mental health care as a family member, patient, and healthcare leader, I’ve seen how critical continuity can be. The difference between recovery and loss is often not whether care exists, but whether it remains connected to patients across the full arc of their lives.

Mental health isn’t episodic. Our care system shouldn’t be either.

Toi Valentine is senior vice president and chief strategy officer of LifeStance Health.